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ANSWERS 



TO 



QUESTIONS PRESCRIBED 

A A BY 

MEDICAL STATE BOARDS. 



BY 

ROBERT B. LUDY, M. D., 

LATE ACTING-ASSISTANT SURGEON, U. S. A., DEMONSTRATOR OF ANATOMY IN PHILA- 
DELPHIA SCHOOL OF ANATOMY, AUTHOR OF "ANSWERS TO QUESTIONS 
PRESCRIBED BY DENTAL STATE BOARDS," ETC. 



PHILADELPHIA : 

JOHN JOS. McVEY, 
1903 



^>9 



THE LIBRARY OF 
CONGRESS, 

Two Copies Received 

MAR 25 1903 

Copyright Entry 
CLASS CO XXo, No 

s-r o t o 

COPY B. 



Entered according to the Act of Congress in the year 19*3 

By JOHN JOS. McVEY. 

In the Office of the Librarian at Washington, D. C. 



"**•** • •• • •• • •• • •• « 1 



PREFACE. 



Many persons having an adequate knowledge of the sub- 
ject in which they are tested, fail, because of their inability to 
interpret properly the intents and purposes of the questions 
to be answered by them. To aid in this, as well as to afford 
a convenient manual for the general preparation of medical 
students in their work, is the sole object of this book. 

Having collected a large number of questions from differ- 
ent States, it was found that duplications occurred ranging 
from 35 to 85%, varying according to the several subjects. 
Thus a comprehensive knowledge of these questions and an- 
swers will serve excellently in the preparation for future 
examinations before such Boards. 

Everything has been sacrificed to brevity and accuracy, 
so that students will find the book indispensable in preparing 
for college, hospital, army or navy examinations in the short- 
est possible time. 

In order to secure a critical interpretation of the questions, 
and concise, yet complete, answers to the same, the author 
has been favored with the assistance of well-known special- 
ists in their several lines, whose competence and experience 
give to the work a range and value impossible of attainment 
in the product of a single author. 

It has been deemed advisable to unite all questions from 
the different States under their respective headings, so that 
undue repetitions of similar questions might be avoided. 

Although standard literature has necessarily been con- 
sulted, yet in a work of this character references would only 
prove cumbersome; hence they have been generally omitted. 

To Drs. Babeock, Boom, Coley, Dorland, Good, Northrop, 

(iii) 



iv PREFACE. 

Salinger and Thomas the author makes grateful acknowledg- 
ment. The high value of their carefully prepared answers is 
fully appreciated by him, and will be by those into whose 
hands the work is committed. 

If this book helps the student to prepare for his examina- 
tions more speedily and with less worry and mental strain 
than formerly, it will have accomplished its purpose and the 
sincere wishes of the author will be realized. 

ROBERT B. LUDY. 



SPECIAL AUTHORS. 



W, Wayne Babcock, M. D. 

Lecturer on Pathology and Bacteriology in Medico-Chirurgi- 
cal College of Philadelphia; Assistant Pathologist to the Phila- 
delphia Hospital, and Joint Author of Vol. V., Cohen's System 
of Physiologic Therapeutics. 

Henry H. Boom, M. D. 

Professor of Chemistry, Physics and Metallurgy in the Phila- 
delphia Dental College. 

Thomas L. Coley, A. B. 9 M. JD. 

Assistant Visiting Physician and Chief of Medical Dispen- 
sary, Methodist Episcopal Hospital ; Assistant Editor Phila- 
delphia Medical Journal ; Associate Editor Therapeutic 
Monthly. 

W. A, Newman Dorland, M. D. 

Associate in Gynecology, Philadelphia Polyclinic ; Assistant 
Obstetrician, Hospital of the University of Pennsylvania ; 
Author of " Modern Obstetrics," System of American Medical 
Dictionaries, etc. 

Wm. Havmar Good, A. M., M. D. 

Demonstrator of Physiology at Medico-Chirurgical College 
of Philadelphia ; Clinical Assistant in Medicine at Samaritan 
Hospital of Philadelphia. 

Herbert L. Northrop, M. D. 

Professor of Anatomy and Associate Professor of Surgery in 
Hahnemann Medical College of Philadelphia. 

Julius L. Salinger, M. D. 

Philadelphia. 

W, Hersey Thomas, M. D, 

Instructor in Surgery in the Medico-Chirurgical College of 
Philadelphia. 

(v) 



CONTENTS. 



PAGB 

I. PRACTICE OF MEDICINE 1 

By Julius L. Salinger, M. D. 

II. THERAPEUTICS AND MATERIA MEDICA 85 

By Thomas L. Coley, M. D. 

III. OBSTETRICS AND GYNECOLOGY 179 

By W. A. Newman Dobland, M. D. 

IV. SURGERY 257 

By W. Hebsey Thomas, M. D. 

V. PATHOLOGY AND BACTERIOLOGY 343 

By W. Wayne Babcock, M. D. 

VI. CHP]MISTRY 369 

By Henry H. Boom, M. D. 

VII. ANATOMY 507 

By Herbebt L. Nobthbop, M. D. 

VJII. PHYSIOLOGY 561 

By Wm. Habmab Good, M. D. 

IX. HYGIENE 625 

By Robebt B. Ludy, M. D. 
(vii) 



PRACTICE OF MEDICINE. 



Differentiate bronchopneumonia and incipient phthisis. 

This is very frequently difficult, incipient phthisis often 
occurring as a localized bronchopneumonia. Bronchopneu- 
monia follows an acute bronchitis, making itself known by a 
rise in temperature over 103° F., by an increase in the respi- 
ratory and pulse rate, the pulse commonly running from 120- 
160 per minute, while the respiratory rate may be from 40-80 
per minute. Bronchopneumonia occurs at the extremes of 
age. The physical signs of well-developed bronchopneumonia 
are, upon inspection, an increased respiratory rate ; on palpa- 
tion, increased vocal fremitus in areas over both lungs; upon 
percussion, localized areas of dulness over both lungs (more 
marked posteriorly) surrounded by a tympanitic area; on 
auscultation, bronchovesicular breathing, subcrepitant rales 
mixed with large and small mucous rales. The physical signs 
are all more marked posteriorly, and are usually well marked 
at the bases. 

Incipient phthisis has a gradual onset with loss of appetite, 
gastric disturbance, slight evening rise of temperature (100° 
or thereabouts), anemia and general malaise. There is, as a 
rule, slight cough with scanty expectoration (the tubercle 
bacillus may be found in the expectorated material) . Occa- 
sionally there is slight hemoptysis or the sputum may be blood- 
tinged; there is a progressive loss of weight. The physical 
signs relate principally to the apices. There is a slight im- 
pairment of resonance at one or both apices on percussion, 
and upon auscultation there may be heard slight friction 
sounds, harsh breathing and some fine moist rales. 



2 PRACTICE OF MEDICINE. 

What are the diagnostic signs of retro=pharyngeaF 
abscess? 

This may follow the infectious fevers, such as scarlet fever 
or diphtheria, usually in young children, occasionally due to 
caries of bone. There is pain on swallowing (dysphagia), 
difficulty in breathing, occasionally hoarseness, cough and 
stiffness of the neck. Upon examination of the throat on 
inspection and palpation there is discovered a fluctuating 
tumor which projects from the posterior wall of the pharynx. 

Differentiate tonic and clonic spasms. 

A tonic spasm is a continuous spasm; a clonic spasm is an 
interrupted one, as contraction and relaxation. 

Describe the characteristics and significance of the 
several kinds of arterial pulse. 

The normal radial pulse is characterized by regularity, fair 
volume, and, in the healthy adult, is from 70 to 80 per minute 
in the erect posture. The pulse of aortic regurgitation is 
known as the water-hammer or Corrigan pulse. It makes 
itself known by an apparent fulness, which, however, soon 
passes, and it recedes from the finger, hence it is also known 
as the receding pulse. The pulse of mitral stenosis is a small, 
irregular, rapid pulse. The dicrotic pulse conveys to the 
finger a double beat. 

Diagnosticate diabetes mellitus. 

The diagnosis of diabetes mellitus consists in the continuous 
presence of glucose in the urine. The amount of urine passed 
by the patient may be from 3 to 5 quarts in the 24 hours ; its 
specific gravity is high, 1030 or over. The color is usually 
straw-colored, and the urine is clear. The patient has great 
thirst, large appetite, as a rule loses weight, and an etherial 
odor may often be detected in the breath; there is pruritus, 
especially of the genitals, and boils and carbuncles are apt to 
form. 

Differentiate gastric cancer from gastric ulcer. 

Gastric cancer occurs after the age of 40, most frequently 



PRACTICE OF MEDICINE. 3 

in the male sex; gastric ulcer is a disease most frequently 
occurring in young females in whom chlorosis is often present. 
Gastric cancer is characterized by loss of weight, marked 
cachexia, and often by the presence of a tumor in the region 
of the pylorus. There is pain which, as a rule, is dull in char- 
acter and not particularly aggravated by food. Vomiting 
occurs after a longer period, 24 hours or more, of food which 
is but partially digested. The Oppler-Boas bacillus may be 
present in the vomited material, and there may also be tinges 
of blood. In ulcer there is pain and marked tenderness in 
the region of the ensiform cartilage. This pain is greatly 
aggravated by the taking of food ; vomiting occurs soon after 
a meal; there is frequently hematemesis. In the examination 
of the gastric contents it will be found that in cancer there is 
an absence of free HC1 and the presence of lactic acid, while 
in ulcer there is an excess of free HCL 

Differentiate scarlatina, measles and roseola. 

In scarlatina the eruption appears late on the first day or 
early on the second day of the disease, while in measles it 
appears on the fourth day, and in roseola the eruption is the 
first symptom of the disease. The onset in scarlet fever is 
abrupt, with a chill or convulsion, high temperature, rapid 
pulse, 140-160 per minute or more, sore throat, etc. In measles 
the onset is characterized by marked catarrhal symptoms, such 
as sneezing, coughing, lachrymation, etc. ; the temperature 
does not, as a rule, run as high as in scarlatina. In roseola 
the constitutional phenomena are slight, the temperature is 
moderate, there is slight sore throat and mild gastric dis- 
turbance. 

How would you diagnose pneumonia? 

The direct diagnosis of pneumonia depends upon the sudden 
onset with chill, temperature which, as a rule, is high, severe 
pain in the side, cough, at first with scanty expectoration, later 
the expectoration becoming very tenacious and containing 
Mood (rusty sputum), and upon the physical signs. These 
consist of the crepitant rale in the first stage, dulness on per- 



4 PRACTICE OF MEDICINE. 

cussion in the second stage with bronchial breathing, and the 
occurrence of the crepitus redux in the third stage. 

Differentiate peritonitis and enteritis. 

In peritonitis there are present marked abdominal pain, 
tenderness on pressure, abdominal distension, after which 
effusion is apt to occur, vomiting, which becomes persistent, 
fever and perhaps the occurrence of collapse; marked consti- 
pation is an important symptom. In enteritis there is diar- 
rhoea, there is rarely marked distension, no abdominal rigidity ; 
sa a rule, there is the history of some dietary error. 

Differentiate organic and functional heart murmur. 

Organic murmurs may be systolic, presystolic or diastolic in 
time. There is evidence of cardiac hypertrophy, dilatation, or 
both. The murmur is conducted in certain definite direc- 
tions (except the presystolic murmur). A thrill is sometimes 
present. A functional murmur is always systolic in time; it 
is heard at the base, particularly at the left base (whereas 
the organic murmur is heard at the punctum maximum), it is 
not transmitted, there is no evidence of hypertrophy or dila- 
tation, and it is present in anemic conditions. 

Describe three pathological pulmonary sounds heard on 
auscultation, and give their significance in diagnosis. 

The friction sound which may be heard in inspiration, expi- 
ration or both, which indicates a fibrinous pleurisy. A crep- 
itant rale, which indicates usually fluid in the vesicular struc- 
ture of the lung. Amphoric breathing, showing a cavity. 

Differentiate aortic stenosis and aortic insufficiency. 

In aortic stenosis the murmur is systolic in time, transmitted 
to the arteries of the neck ; a systolic thrill is also often pres- 
ent, there is some evidence of hypertrophy of the left ventri- 
cle, the pulse is full and, as a rule, not rapid. In aortic 
regurgitation the murmur is diastolic in time, heard at the 
left base, conducted down the sternum. The water-hammer 
or Corrigan pulse is present. ' There is marked evidence of 



PRACTICE OF MEDICINE. 5 

hypertrophy of the left ventricle. Occasionally the "Flint 
murmur" may be heard. 

Differentiate typhoid fever and remittent fever. 

In typhoid fever prodromes are present, such as loss of 
appetite, headache, diarrhea, evening fever, becoming more 
marked each succeeding night. On or about the 7th day the 
characteristic eruption appears, the typical tongue makes its 
appearance, the spleen is enlarged, and ; the dicrotic pulse is 
found during the second week. The Widal and diazo reac- 
tions are present. Remittent fever may be present in many 
of these cases; there is, however, no Widal or diazo reac- 
tion, no dicrotic pulse, and the presence in the blood of the 
Plasmodium malarias will in all cases lead to a correct diag- 
nosis. 

Describe four peculiar appearances of the tongue and 
give their significance in diagnosis. 

A flabby, indented, swollen tongue, covered with a yellowish 
fur, shows catarrhal gastritis. This tongue is also seen in 
smokers and drinkers, and occurs often in moderate fevers. 
A tongue which is red at the edges and tips and is coated pos- 
teriorly occurs in enteric fever. The "strawberry" or cat 
tongue, in which the papillas are elevated and a slight grayish 
fur is seen, occurs in scarlet fever. Furrings which are small 
and limited indicate irritation from a rough tooth or inflam- 
mation of a tonsil. 

Differentiate acute rheumatism and periostitis. 

Acute rheumatism is characterized by redness, swelling and 
pain in the joints, by fever of a moderate range, by acid 
sweats and a constant tendency to inflammation of the serous 
membranes of the heart. Periostitis, as a rule, follows an 
injury; the pain is more localized and does not refer to the 
joints : there are no acid sweats, and pus formation may occur, 
which is exceedingly rare in acute rheumatism. 

Differentiate neuritis from myalgia. 

In neuritis the pain is. as a rule, along the nerve trunks; 



6 PRACTICE OF MEDICINE. 

trophic changes may occur. In myalgia pain is over the mus- 
cles; there is no constitutional disturbance; fever is entirely 
absent; pressure upon the affected area in myalgia gives re- 
lief ; in neuralgia the pain is aggravated by pressure. 

Describe the symptoms of yellow fever. 

For convenience of description the disease is divided into 
three stages: The stage of onset, which generally lasts three 
days ; the period of calm, which lasts from 12 to 24 hours ; and 
the period of collapse, the duration of which is indefinite. In 
the first stage there is headache, pain in the bones, nausea and 
vomiting, moderate fever, the pulse may be 80 to 100 in a min- 
ute, and becomes progressively slower as the disease advances, 
the urine is albuminous ; there may be even in this stage slight 
jaundice. These symptoms disappear more or less abruptly 
and give place to the stage of calm, in which all the previous 
symptoms disappear; and recovery from this stage may be 
uninterrupted. If this favorable event should not occur, the 
third stage is ushered in, with the appearance of marked jaun- 
dice, from which the disease receives its name. There may be 
hemorrhage from any of the internal organs, most frequently, 
however, from the stomach, the characteristic black vomit. 
The symptoms of the first stage are added to this. 

Give the diagnosis of gastric ulcer. 

The disease is most frequent in young anemic females. 
There is pain and tenderness on pressure in the region of the 
ensiform cartilage; there is hematemesis, and obstinate con- 
stipation. Examination of the gastric contents shows an 
excess of HC1. 

Give the symptoms resulting from paralysis of the 
phrenic nerve. 

This is a paralysis of the diaphragm, if the condition is bi- 
lateral; no movement is noted on the abdomen and epigas- 
trium; the hypochondrium is drawn in; marked dyspnea 
occurs upon the slightest exertion. There may be enlarge- 
ment of the chest. 



PRACTICE OF MEDICINE. 7 

Differentiate acute bronchitis from croupous pneumonia. 

In croupous pneumonia the onset is rapid, with marked chill, 
high temperature, "stitch in the side," rusty sputum, cough, 
rapid breathing and the physical signs, consisting of crep- 
itant rale in the first stage, consolidation in the second stage, 
crepitus redux in the third stage. In acute bronchitis there 
is rarely high temperature, but cough, slight pain under the 
sternum is prominent. On auscultation there are heard in 
the first stage, dry rales, which change to moist rales ; there is 
never evidence of consolidation. 

What is the significance of the patellar reflex as a sign 
of disease? 

Absence of the knee jerk is caused by a lesion affecting any 
region of the reflex arc; it is, therefore, lost in disease affect- 
ing either motor or sensory fibers or both, as in neuritis, in 
disease of the posterior roots or columns, as in Friedreich's 
ataxia. It may be absent in apoplexy, epilepsy, injury to the 
cord and in meningtis; it is sometimes absent in diabetes, 
diphtheria and chorea. It is exaggerated in hemiplegia fol- 
lowing apoplexy, in the cerebral palsies of children, in general 
paralysis of the insane, also in hysteria, neurasthenia and 
strychnine poisoning. 

Diagnosticate acute pericarditis. 

Pain in the pericardium, irregular action of the heart, 
dyspnea, slight fever and a friction sound over the pericar- 
dium on auscultation. Occasionally friction fremitus may 
be noted. 

Differentiate epilepsy from hysteria. 

Epilepsy is often preceded by an aura, followed by complete 
loss of consciousness. These are at first tonic, followed by 
clonic, convulsions; during the attack the pupils are dilated; 
the patients often bite their tongue. In hysteria there is never 
complete loss of consciousness; there is no regularity with 
regard to the convulsion; it is most common in females be- 
tween the ages of 15 and 25 ; the pupils are irregular, hystero- 



8 PRACTICE OF MEDICINE. 

genie zones are present, the patient never falls so that she 
may be injured. 

Differentiate neuritis and rheumatism. 

In neuritis the pain is commonly along the nerve trunks; 
trophic changes occur ; there may be foot-drop or wrist-drop ; 
fever is slight. In rheumatism there is redness, swelling and 
pain in the joints, acid sweats, frequent implication of the 
membranes of the heart, marked deposits of urates in the 
urine. 

Differentiate acute phthisis and capillary bronchitis. 

There is a form of acute pulmonary phthisis which is known 
as the bronchopneumonic form, which can with the greatest 
difficulty only be differentiated from so-called capillary bron- 
chitis. The main points of difference would consist in the 
progressive emaciation, a family history of tuberculosis, the 
finding of tubercle bacilli in the septum, and the appearance 
of the physical signs in the lungs. 

What are the clinical manifestations of biliary calculi? 

As long as the calculi remain quiescent in the gall-bladder 
no symptoms arise. It is only upon the passage of the gall- 
stones into the duct that the symptoms of hepatic colic arise, 
which consist in great pain in the region of the liver, radiating 
toward the umbilicus and right shoulder-blade, nausea and 
vomiting and, after the passage of stones, jaundice, clay- 
colored stools and the appearance of biliary pigments in the 
urine. 

Differentiate empyema from pulmonary abscess. 

In pulmonary abscess there is a fever of a septic type, the 
physical signs of a cavity are commonly present, frequently 
expectoration of foul-smelling pus, which under the micro- 
scope shows elastic fibers. In such cases leukocytosis is pres- 
ent. In empyema there are the usual signs of pleural effusion, 
the temperature may range from 102° to 105°, displacement of 
the heart and the adjacent organs is common, local edema 
and redness of the skin are often present. 



PRACTICE OF MEDICINE. 9 

Describe the diagnostic characteristics of the eruption 
of typhoid fever, smallpox and chicken=pox. 

The eruption of typhoid fever appears about the seventh 
day, consisting of slightly elevated, rose-colored spots, which 
disappear on pressure and appear again after the pressure is 
removed ; they occur in crops, having a duration of from two 
to three days ; they appear commonly on the abdomen, chest, 
between the shoulder-blades, extremely rarely upon the face. 
The eruption of smallpox appears on the third day in the form 
of a macula, passing through the successive stages of vesicle, 
pustule, crust and scar. The pustule is umbilicated and has 
an inflammatory areola; the eruption appears all over the 
body, especially on the exposed parts. The eruption of 
chicken-pox appears on the first day; it appears as a small 
reddish papule, which in a very few hours becomes a vesicle ; 
the vesicle is thin and transparent. 

Differentiate diphtheria from follicular tonsillitis. 

In diphtheria the exudate is found upon all parts of the 
posterior pharynx, uvula and tonsils. Around the exudate 
there is an inflamed areola. The exudate is removed with 
great difficulty, leaving a bleeding surface, the false mem- 
brane rapidly reforming. In follicular tonsillitis the exudate 
is strictly limited to the crypts of the tonsils ; it is wiped away 
with ease, without leaving a bleeding surface, and it does not 
reform. The Klebs-Lomer bacillus is found only in the diph- 
theritic exudate. 

Differentiate acute enteritis from acute dysentery. 

In dysentery the important symptoms to be considered are 
tormina, tenesmus and stools composed of mucus and blood. 
These symptoms in acute enteritis do not occur in anything 
like the severity and constancy that they do in dysentery. 

Differentiate appendicitis from enteric fever. 

As a rule, appendicitis begins abruptly, with marked pain 
in the right iliac fossa over McBurney's point. There is con- 
stipation, tenderness, board-like rigidity, all this occurring, 



10 PRACTICE OF MEDICINE. 

as a rule, within a few days. The onset of enteric fever is 
gradual, with prodromes of diarrhea, headache, characteristic 
tongue, appearance of the eruption about the seventh day, 
enlargement of the spleen, dicrotic pulse, Widal reaction. 

Differentiate acute pericarditis from acute endocarditis. 

In pericarditis there is pain in the pericardium. This, as- 
a rule, is absent in endocarditis. In pericarditis there is a 
friction sound, which may be either systolic or diastolic, but, 
as a rule, is not related to either. In endocarditis there is a 
murmur, which is either systolic, diastolic or presystolic; the 
murmur is transmitted, the friction sound is localized. The 
murmur is heard at the punctum maximum ; the friction sound 
is heard over the body of the heart and is nearer the ear. 

How would you diagnose a case of rickets? 

Sometime between the seventh month and second year of life 
the patient shows irritability, restlessness and some fever 
toward evening, dentition is delayed and gastro-intestinal 
disturbances follow; there is profuse sweating. The shape 
of the head is characteristic; it is rectangular, the face ap- 
pearing small in proportion to the skull, bone changes are 
noted, and the rachitic rosary appears. 

Differentiate variola and varicella. 

In variola the eruption appears on the third day, preceded 
by marked constitutional symptoms. The eruption goes 
through the successive stages of macule, papule, vesicle, pus- 
tule, which is umbilicated and surrounded by an inflammatory 
areola, crust and scar. The eruption in varicella appears on 
the first day and is vesicular almost from the beginning. 
There are rarely marked constitutional phenomena, and the 
disease is essentially one of childhood. 

Differentiate apoplexy from uremic coma. 

This is often very difficult; however, the following points 
favor apoplexy: Profound coma, the face may be pale and 
cyanotic or flushed; respiration is stertorous and slow and 



PRACTICE OF MEDICINE. 11 

may be of the Cheyne-Stokes type ; hard arteries, with a slow, 
hard, irregular, full pulse; the pupils are dilated or unequal 
and do not react to light ; conjugate deviation of the head may 
be present ; there is evidence of paralysis ; the skin is hot and 
dry ; the coma in uremia may be preceded by, or accompanied 
with, convulsions; the face may be pale and edematous; the 
pulse is slow and of high tension, showing either hypertrophy 
of the heart or sclerosis of the vessels ; there may be a urinous 
odor exhaling from the patient ; frequently there is edema of 
the feet; albumin and casts are found in the urine; albumi- 
nuric retinitis may be present. 

Differentiate unconsciousness from apoplexy, syncope 
and alcoholic intoxication. 

(Apoplexy see above.) In syncope the face is very pallid, 
the pulse is very weak, and the pupils are markedly dilated. 
In alcoholic coma the unconsciousness is rarely complete. The 
alcoholic odor of the breath is not diagnostic, as apoplexy and 
uremia may occur in persons that have been drinking. The 
pulse is at first rapid and full, later becoming small and fee- 
ble. The pupils are equal and often dilated. The skin is 
cool and moist and the temperature subnormal. 

Differentiate cardiac hypertrophy from cardiac dilata= 
tion. 

In cardiac hypertrophy the apex-beat is displaced down- 
ward and to the left. The first sound of the heart is strong 
and booming. The pulse is slow and strong. In cardiac dila- 
tation the apex-beat is displaced to the right. It is diffused 
and feeble, the first sound being weak. The pulse is often 
rapid, irregular and weak. 

Differentiate Asiatic cholera from cholera morbus. 

This often presents great difficulties, especially in times of 
an epidemic of cholera; however, the finding of the comma 
bacillus will in all cases clear up the diagnosis. Rice water 
discharges are much more common in true cholera. In cholera 
morbus there is usually the history of an indiscretion in diet. 



12 PRACTICE OF MEDICINE. 

Differentiate heat exhaustion from sunstroke. 

In heat exhaustion premonitory symptoms occur, such as 
dizziness, headache, nausea and vomiting. The respirations 
are increased in number, and the pulse is very rapid, 130-140 
per minute. Unconsciousness is not profound. The temper- 
ature may be normal or subnormal, or slight fever may be pres- 
ent. In sunstroke there may or may not be prodromes. The 
temperature is very high, from 106°-115°, or even higher. 
Dyspnea is marked, and the skin of the body is red and some- 
times even livid. The pupils are contracted and the pulse is 
very rapid. There is complete unconsciousness in which con- 
vulsions may occur. Cheyne-Stokes breathing may be present. 

Diagnosticate parenchymatous nephritis. 

The face is pale and edematous. The pulse is full and 
strong, showing some hypertrophy of the heart at first, al- 
though this is not nearly as common as in the interstitial 
variety. The urine is decreased in amount, of high specific 
gravity, high colored, and contains large amounts of albumin 
and casts. Often there is also edema of the lower extremity. 

Differentiate aortic and mitral valvular diseases. 

In aortic disease the murmur is heard with the greatest in- 
tensity at the aortic cartilage (second right costal cartilage) ; 
it is either transmitted to the neck, if it be systolic, or it is 
transmitted down the sternum, if the murmur be diastolic in 
time. In aortic valvular disease there is always hypertrophy 
of the left ventricle. In mitral disease the murmur is heard 
at the apex. It is transmitted to the axilla and the angle of 
the scapula if the murmur be systolic in time. The presys- 
tolic murmur is not transmitted and is accompanied with a 
presystolic thrill. 

Diagnosticate acute epidemic catarrh (La Grippe, In= 
fluenza). 

There is sudden onset, with chill and commonly high tem- 
perature. There is a marked prostration, out of proportion to 
all the other phenomena, catarrhal symptoms, especially of 



PRACTICE OF MEDICINE. 13 

the respiratory tract. The disease is characterized by many 
complications and a great variety of sequelae. 

When is perforation in typhoid fever most likely to 
occur? 

Sometime in the course of the third week. 

Describe the essentially different sounds given by the 
thorax on percussion. 

Tympany is elicited over the trachea, resonance over the 
lungs, dulness over the heart. 

In what cases would the ophthalmoscope aid in diag= 
nosis? 

In disease of the arteries (retinal hemorrhages). In dis- 
ease of the kidney, in disease of the nervous system, syphilis, 
tobacco-poisoning, lead-poisoning, tubercular meningitis, dia- 
betes, etc. 

Differentiate in a general way between cerebrospinal 
fever and tubercular meningitis. 

The onset of tuberculosis is not as sudden as in cerebro- 
spinal meningitis ; the pains, hyperesthesia and retraction are 
less, and there are no eruptions. Retraction of the abdomen, 
irregular pulse and Cheyne- Stokes respiration are much more 
frequent. A pre-existing tuberculous lesion may be found, 
and the ophthalmoscope may reveal tubercles in the choroid. 

What does bronchial breathing indicate? 

This is heard normally when listening over the trachea. It 
is encountered over airless spaces in the lung tissue and over 
cavities. 

In what diseases can we employ the microscope to ad= 
vantage as an aid in diagnosis? 

Principally in diseases of the blood and kidney. It is also 
necessary in the examination of all secretions and excretions 
for pathogenic organisms and parasites. 



14 PRACTICE OF MEDICINE. 

Describe the physical signs of simple ascites and those 
of ovarian dropsy. 

In ascites, if the patient be lying upon the back, the center 
of the abdomen is flat (provided the amount of fluid is not 
excessive), the lateral and dependent portions bulge. There 
will be tympany over the region oi' the umbilicus and flatness 
in the flanks. Fluctuation will be obtained. In dropsy due 
to ovarian disease the accumulation of the fluid is local (in 
the region of the ovary) ; it does not change with the position 
of the patient. If the accumulation be great, the differential 
diagnosis is very difficult ; vaginal examination must be made, 
and sometimes the character of the dropsy can only be deter- 
mined from the fluid withdrawn. 

Differentiate the early eruption of syphilis and measles. 

In syphilis there is the history of the chancre, and quite a 
period (six weeks) before the eruption appears. Coincident 
with the eruption there is inflammation of the throat (mucous 
patches) . There is rarely any fever. The eruption is copper- 
colored, and is not particularly prominent on the face. In 
measles there is marked fever from the onset, with severe 
catarrhal symptoms. The eruption does not appear before 
the fourth day, it occurs prominently on the face and rapidly 
spreads all over the body, the catarrhal symptoms continuing. 

What are the methods of physical diagnosis or exp!ora= 
tion? 

Inspection, palpation, mensuration, percussion, auscultation 
and succussion. 

Describe the symptoms and treatment of acute inflam* 
matory articular rheumatism. 

The disease, as a rule, begins with pain, swelling and red- 
ness of one or more of the large joints. The joints implicated 
are symmetrical. There is moderate fever, 102°-103°, acid 
sweats and marked urates in the urine. There is a tendency 
to implication of the serous membranes of the heart. There 
are two common modes of treatment, the salicylate and the 



PRACTICE OF MEDICINE. 15 

alkaline treatment. In some cases these two modes of treat- 
ment are combined. 

Describe the symptoms of a case of apoplexy due to 
cerebral hemorrhage. 

Prodromes may precede the attack, such as nausea, vomit- 
ing, vertigo. As a rule, the attack comes on suddenly, the 
patient becoming comatose. The face is flushed or pale. There 
is stertorous breathing, occasionally of the Cheyne-Stokes 
type. There is conjugate deviation of the head and eyes ; the 
pupils are irregular, and there is evidence of hemiplegia. 

Differentiate acute bronchitis from lobar pneumonia. 

In acute bronchitis there is cough, at first without, later 
with mucopurulent expectoration; subfebrile temperature, 
and slight pain under the sternum. There are no changes 
from the normal on percussion, but upon auscultation there 
are at first dry rales, followed by moist rales. Lobar pneu- 
monia is characterized by sudden onset, with marked chill, high 
temperature, "stitches in the side," cough, a sputum which 
is very tenacious and often rusty; full pulse at first, later 
becoming rapid. The physical signs are quite characteristic. 
There is, in the first stage, the crepitant rale, in the second 
stage dulness on percussion with bronchial breathing and, in 
the last stage, ' ' crepitus redux. ' ' 

Differentiate hemoptysis and hematemesis. 

Hemoptysis. Hematemesis. 

Blood is bright red and frothy; often Blood is dark, clotted and often 
coughed up. mixed with food; is vomited. Stools 

may be tarry. 
Alkaline in reaction. Acid in reaction. 

Containing air bubbles. Air bubbles absent. 

Tubercle bacilli may be present in the No tubercle bacilli in the blood, 
blood. 

Differentiate rheumatism from gout. 

Gout occurs suddenly and shows a special preference for 
the smaller joints, especially the great toe. Rheumatism 
comes on more gradually and attacks principally the large 



16 PRACTICE OF MEDICINE. 

joints. The appearance of the joint in gout is swollen, glossy, 
tense and bluish. There is less sweating and less fever than 
in rheumatism; gastric and nervous symptoms are never 
prominent. Implication of the membranes of the heart in 
gout is decidedly less frequent than in rheumatism. 

Differentiate intestinal colic, uterine colic and renal 
colic. 

Intestinal Colic. — Diffuse pain, which may be localized, 
very severe in character ; usually of sudden onset, relieved by 
pressure ; lasting, as a rule, a few hours. A free discharge of 
flatus relieves the attack. 

Uterine Colic. — The pain is in the pelvis, there is some his- 
tory of uterine discharge and disease. 

Renal Colic— The pain starts from the region of the kidney, 
shooting down the ureter. There is retraction of the testicle ; 
often nausea and sometimes vomiting. 

Give the physical signs of the most usual valvular lesions 
of the heart. 

Mitral insufficiency is the most common valvular lesion of 
the heart. The physical sign is a murmur at the apex, systolic 
in time and transmitted to the left axilla and the angle of the 
scapula. 

Differentiate pleurisy and pneumonia. 

In pleurisy there is a friction sound heard commonly both 
in inspiration and expiration ; fever is slight, there is marked 
pain in breathing. There may be slight cough. In the first 
stage of pneumonia there is a pleurisy, especially when the 
inflammatory exudate reaches the periphery of the lung. 
There is high fever, which is preceded by a marked chill, 
cough, rusty sputum and the physical signs (crepitant rale, 
dulness on percussion, bronchial breathing and crepitus 
redux). 

What conditions might cause alvine discharges contain- 
ing fat? 

In obstructive jaundice fatty stools are sometimes noted; 



PRACTICE OF MEDICINE. 17 

they occur occasionally in overfed infants. Fatty stools are 
often indicative of disease of the pancreas, such as cancer or 
pancreatic calculi. 

Give the characteristic symptoms of purpura hemor= 
rhagica. 

Hemorrhages from the mucous membranes and extravasa- 
tion in the cutaneous surfaces ; great weakness, anemia due to 
loss of blood. Fever is present, as a rule. 

What conditions increase the amount of uric acid voided 
with the urine? 

Increased by diet (fat and sugar), muscular exercise. In 
the acute fevers (pneumonia and rheumatic fever), in leuke- 
mia and in disease of the spleen generally ; in diabetes and in 
lithemia. It is decreased in amount under strict milk diet, in 
anemia, chronic lead-poisoning and chronic interstitial neph- 
ritis. 

Differentiate thrombosis and embolism. 

Thrombosis. — Prodromes are common, drowsiness and head- 
ache, the onset of the attack is insidious. Hemiplegia gradual 
in onset. Ocular and other nerve palsies. 

Embolism. — Loss of consciousness rapid, hemiplegia and 
disturbances of the pulse and respiration. Embolism is more 
frequent in the left side of the brain, hence valvular disease 
favors embolism. 

What diseases are liable to occur in the right inguinal 
region? 

Appendicitis, floating kidney, disease of the liver and of the 
bladder. 

Distinguish between the terms illusion, delusion and 
hallucination as used in diagnosis. 

An illusion is a wrong conception of an object which really 
exists. A delusion is an absurd and unfounded belief. A 
hallucination is a sense perception without a physical basis. 

2 



\& i'li ACT ICE OF MEDICINE. 

Give the physical and rational signs of pericarditis be, 
fore and after effusion. 

There is slight fever, marked pain in the precordial region, 
dyspnea and irregular, usually quickened, pulse. There is 
pericardial friction on auscultation. When effusion occurs 
the friction disappears ; there is dulness in the precordial area, 
the base of dulness being at the apex of the heart, quite the 
reverse from the usual condition. 

Define vocal fremitus and state its significance in pul= 
monary disease. 

Vocal fremitus means the vibrations of the voice whicfi 
are transmitted to the chest wall. These are conducted from 
the larynx by the trachea and bronchi to the smaller tubes 
within the lungs, and thence through the lung tissue to the 
surface. Vocal fremitus is increased by consolidated lung 
tissue ; it is increased from an empty pulmonary cavity superr, 
ncially situated, and is diminished or lost on accumulation of 
fluid in the pleural cavity. 

1 ^ lvl 

Differentiate between sunstroke (coup de soleil) and 
apoplexy. 

In sunstroke there is the history of exposure to the sua^ 
The temperature is very high, 105° -115° or over, but no evi- 
dence of hemiplegia. In apoplexy there is conjugate devia-, 
tion of the head and eyes, hemiplegia, irregular pupils, never 
so high a temperature, and full, bounding pulse. 

What casts are frequently found in albuminous ur*ne 
and what do they denote? ^no'isai 

Hyaline, granular, epithelial and blood casts. Hyaline 
casts probably result from the exudation or secretion of a, 
material from the epithelial cells lining the tubules. They 
are sometimes found in healthy individuals. Granular casts 
indicate nephritis. Epithelial casts are always indicative of 
a,jreual lesion. Blood casts are found in acute parenchyma- 
lous nephritis or in ? condHion in which the renal tubules 
be<m& (illt ^ Wfi 1V(1 bloodeorpusdes. 



PRACTICE OF ME DIC I XE. iy 

Of what import is the spleen in the diagnosis of febriJe 
conditions? Give the topography of the spleen. 

As a rule, the spleen is enlarged in all febrile conditions. 
The spleen extends from the ninth rib to the margin of the 
twelfth rib in the midaxillary line of the left side. 

Differentiate the crepitant rales and the subcrepitant 
rales and give the clinical significance of each. 

The crepitant rale is a fine moist rale and is heard only at 
the end of inspiration. It is found in the vesicular structure 
of the lung. The subcrepitant rale is also a fine moist rale,, 
somewhat coarser than the crepitant rale, found in the finer 
bronchi and heard both in inspiration and in expiration. 
The crepitant rale is heard in croupous pneumonia, broncho- 
pneumonia, hemorrhage, pulmonary infarcts, edema of the 
lung and sometimes in tuberculosis. The subcrepitant rale 
is heard in congestion and edema of the lungs, in hemorrhage 
or in any condition in which fluid is present in the finer bron- 
chi : in pulmonary tuberculosis, in the third stage of croupous 
pneumonia and in bronchopneumonia. 

What are the manifestations of hereditary syphilis? 
YBtn snoiJBDiTomoD jBnVT .211 * 

The child at birth is very feeble, and the eruption may bg 
present ; the child snuffles, the mouth is fissured, and the lips 
are ulcerated. Liver and spleen are enlarged, and bone symp- 
toms are prominent. If the symptoms do not appear at birth, 
they will appear at or about the third month. There is then 
nasal catarrh, with a seropurulent discharge. Necrosis of 
bone is rapid, and the nose undergoes a characteristic de- 

formitv. Lesions of the skin also appear. "When the teeth 
mf^f \ orfrgp dan ft fists i j 

appear thev are notched (Hutchinson s teeth).. 

Make a diagnosis of aneurysm of the descending aorta. 

.^/j^ere is marked pain, especially in the back, and a large 
^uj&o-F^afy}; appear posteriorly in the scapular region. Para- 
ftiegi^flnag ^^u^ro^L pressure on tne corc ^ dysphagia from 
^?sSur^o^/i$teiJ§s^agus. and pulmonary symptoms from 
pressure on the left bronchus. There are. besides, all JJjg 



20 PRACTICE OF MEDICINE. 

physical signs of aneurysm in any other locality, such as ex- 
pansible pulsation, tumor, bruit and thrill. 

Make a differential diagnosis of pleuritic and pericardial 
effusion. 

If the pericardial effusion be very great, it may much 
resemble a left-sided pleural effusion. In pericardial effusion, 
however, there is pulmonary resonance at the base, Skodaic 
resonance in the axilla, and the heart is not displaced to the 
right of the sternum. The dyspnea is greater in pericarditis 
with effusion, and the paradoxical pulse may be present. An 
antecedent history of rheumatic fever may help the diagnosis 
and favor pericarditis. 

Describe the treatment of hay fever. 

A change of residence before the annual attack is the only 
prophylaxis ; a correction of the neurotic and gouty tendency 
of the individual should be attempted. A spray to keep the 
nasal passages clean is important. A weak solution of cocaine 
for this purpose is valuable. Suprarenal extract appears to 
give the best results both locally and internally. 

Define epidemic parotitis. What complications may 
arise in the course of this disease? 

There is abrupt development of fever and an enlarged par- 
otid gland on one side. Inflammatory edema of the surround- 
ing tissue is common, the ear may be pushed upward. The 
mouth is displaced and the face disfigured. The fever is 
usually about 102°. In some cases the* opposite gland becomes 
affected after a few days. Suppuration does not occur. 
Occasionally other glands, such as the testicles, ovaries and 
mammary glands, are affected. 

Define anemia, chlorosis. 

By the term anemia is meant a deficiency of the blood, either 
in its bulk or in certain of its constituents. Chlorosis is a 
form of primary anemia, affecting chiefly females at the time 
of puberty, and characterized by marked diminution of the 
hemoglobin. 



PRACTICE OF MEDICINE. 21 

Give the etiology and describe the symptoms of idio= 
pathic erysipelas. 

It occurs at all seasons of the year and in all climates. It 
is most liable to occur in debilitated and cachectic persons 
and in the course of chronic pulmonary tuberculosis. The 
disease may occur in the puerperal state. The exciting 
cause is the streptococcus erysipeiatis of Fehleisen. The dis- 
ease begins with a chill or chilliness, and is followed by the 
development of the eruption. There are gastro-intestinal 
symptoms or fever. The skin becomes irritated, itchy and 
swollen. There are heat, tension and burning in the part. 
The eruption shows decided elevation with a distinct, promi- 
nent margin, it is red or puffy in the center and glossy in 
appearance. Uncomplicated cases last from two to three 
weeks. 

Mention the causes and describe the treatment of pri= 
mary lobar pneumonia. 

The exciting cause is the diplococcus or pneumococcus of 
Frankel. Exposure to cold and wet, alcohol, are said to be 
predisposing causes. The treatment of the disease consists 
in giving the preliminary purge, preferably calomel. Dover 's 
powder or a hypodermic injection of morphine to relieve the 
pleural pain, remedies to sustain the heart and respiration, 
such as alcohol and strychnine, are useful. Ammonium car- 
bonate and ammonium chloride are also of value. 

Describe the treatment of hydrothorax. 

Purges, diaphoretics and diuretics are of value. If these 
remedies do not relieve the condition the aspirator must be 
resorted to. 

State your treatment, including diet, of typhoid fever. 

If the patient be seen before the tenth day of the disease, 
a calomel purge should be administered. The systematic cold 
bath of Brand is a favorite method of treatment. Alcohol 
and strychnine are valuable adjuncts to sustain the circula- 
tion. The diet should be absolutely liquid. Water plenti- 



22- PRACTICE OF MEDICINE. 

fully, iinlk, liquid pcpionoids are commonly employed. No 
solid nor semi-solid food should be administered before the 
evening temperature has been normal for at least one week. 

Describe the treatment of diabetes mellitus. 

Diet is most important. No starches or sugars should be 
given. The diet should consist in the fresh green vegetables, 
meat, fish. No alcoholic or malt liquors had better be em- 
ployed. The generally accepted treatment is by some form 
oi opium, codeine being most oiten employed. 

Give the symptoms and treatment of tetanus. 

The prominent symptoms are the occurrence and recurrence, 
at varying intervals, of tonic spasm of greater or lesser inten- 
sity in the voluntary muscles. The spasm is usually first 
noticed in the neck, which is soon followed by spasm of the 
muscles of the jaw, with inability to open the mouth. There 
is pain, which, however, is not severe. Occasionally the body 
arches backward, a condition known as opisthotonos. There 
is usually fever of about 101°, but after prolonged spasm 
hyperpyrexia may occur. The urine is scanty, extremely 
toxic and often contains albumin. Profuse sweating is a 
prominent symptom. The treatment consists in the endeavor 
to administer nutriment, and rectal injections should be re- 
sorted to. Chloral is of value because it produces sleep and 
sometimes relaxes spasm. Antitetanic serum is of value in 
some cases. The wound should be thoroughly cleansed and 
treated antisepticallyiorfi 

What is the most common cause of tabes dorsalis? 

Syphilis. oJ 

How should acute coryza be treated? 

Acute coryza should be treated by cleansing the nose with a 
mild antiseptic solution; a weak solution of cocaine is also of 
value. Dover's powder is also recommended internally. 

Describe the treatment of pleurisy with effusion. 

■ The common measures administered to absorb fluid, such as 



PRACTICE OF MEDICINE. 23 



ptirges, diaphoretics and diuretics, should be resorted to. If 
these fail the aspirator may be used. 



What is the period of incubation in variola and vaccinia? 

The period of incubation of variola is from ten to thirteen 
days. The period of incubation in vaccinia varies from three 
to seven days, depending upon whether humanized or bovine 
virus is used. 

■ 
What are the symptoms of hepatic abscess? In what 

climates is hepatic abscess most likely to occur? 

The symptoms of hepatic abscess are an enlarged and tender 
liver, with jaundice, anemia and wasting. The clinical mani- 
festations vary, and large abscesses may be present without 
marked disturbance. Occasionally fluctuation may be de- 
tected in the liver. There may be pain of a throbbing char- 
acter. Occasionally all the phenomena of sepsis are present, 
chills, fever and sweating. This disease is most common in 
hot climates. 

How may pleuritis in its early stages be differentiated 
from intercostal neuralgia? 

In pleuritis there is pain, which is especially aggravated by 
breathing. In intercostal neuralgia the pain is over the exit 
of the intercostal nerves. It is increased by pressure. In 
pleuritis the pain is diminished by pressure. The pain is not 
aggravated in intercostal neuralgia by deep breathing. In 
pleurisy there is a friction sound, which does not occur -in- 
intercostal neuralgia. Frequently intercostal neuralgia is 
accompanied by the development of herpes zoster. 

How many and what are the stages of malarial inter- 
mittent fever? 

There are three stages : The stage of chill, the stage of fever, 
and the sweating stage. 

Give the treatment of epilepsy. 

' The general health should be carefully looked after, the 
bowels kept open, and the diet regulated. The medicinal 



24 PRACTICE OF MEDICINE. 

treatment is chiefly empirical, the best results having been 
obtained from the use of the bromides. 

Mention the eruptive fevers. 

Scarlet fever, measles, German or French measles or rubella, 
variola, varicella and erysipelas. 

Describe the treatment of intermittent fever. 

The treatment of intermittent fever consists in the admin- 
istration of quinine in sufficient doses to destroy the Plasmo- 
dium of malaria. From 10 to 20 grains a day for an adult is 
sufficient for this purpose. 

Outline the treatment of variola. 

The prophylaxis consists in vaccination, complete isolation 
and disinfection. There is no specific treatment. Food is 
not well borne at first, as there is much vomiting and diarrhea. 
Acid drinks and small particles of ice are grateful to the 
patient. Detergent washes and antiseptic solutions should 
be used for the mouth. The room should be darkened. 
Warm baths two or three times daily are of benefit to the 
patient. During the secondary fever bold stimulation is 
necessary. A mild laxative at the onset is useful. If there 
be great pain, opium must be resorted to. In convalescence 
tonics are of service. 

Give the etiology and outline the treatment for acute 
gastritis. 

In the majority of instances the condition is due to irritants, 
either thermic or chemical, that come in contact with the 
mucous membrane of the stomach, producing an acute inflam- 
mation. Food either too hot or too cold, spices, drugs and 
poisons may have this influence on the mucous membrane. 
The treatment consists in the administration of a purge, such 
as calomel or castor oil. The diet should be restricted for a 
while. In severe cases it is necessary to produce vomiting. 
Lavage is useful. Drugs are scarcely ever necessary. 



PRACTICE OF MEDICINE. 25 

Describe the symptoms and treatment of chronic hydro- 
cephalus in children. 

The symptoms of congenital hydrocephalus are difficulty in 
the movements of the child on account of the weight of the 
head. As a rule there is impairment of intellect. The head 
is often enormous in size. There may be headache and dim- 
ness of vision, and the gait may become irregular. The pulse 
is usually slow. Medical treatment is of no avail in this con- 
dition. Operative methods are advised by some authorities. 

Define rubeola and describe its symptoms. 

Rubeola is an acute, infectious, contagious disease charac- 
terized by marked catarrhal symptoms, especially of the res- 
piratory tract, with a characteristic eruption occurring on the 
fourth day. The disease may begin with a chill, followed by 
fever that may reach 103° F. or higher, with marked catarrhal 
symptoms from the onset. There is injected conjunctiva, 
lachrymation, photophobia, coryza. and some cough. Rales 
are heard in the chest. Koplik's sign may appear about this 
time. On the fourth day the eruption appears, which consists 
of rose-red or brownish maculo-papular points raised above 
the skin, with intervening healthy skin, often arranged in 
crescentic shape. The eruption remains at its height for about 
four days. The catarrhal symptoms continue. About the 
eighth day of the disease the eruption begins to fade. A fine 
desquamation occurs. In the absence of complications the 
disease lasts about twelve days. 

Describe the symptoms and treatment of gangrene of the 
lung. 

Cough accompanied by expectoration, which is abundant, 
thin and foul-smelling, should call attention to gangrene of 
the lung. Fever is always present. There is often hemop- 
tysis. Microscopically the sputum contains leukocytes, shreds 
of lung tissue, especially elastic fibers, fat crystals and bac- 
teria. Upon percussion over the affected area dulness is pres- 
ent. Upon auscultation, bronchial breathing and, if excava- 



26 PRACTICE OF MEDICINE. 

tion occurs, signs of a cavity are present. The treatment is 
supportive. 

Describe the symptoms of tubercular meningitis. 

The course of the disease is usually divided into a pro- 
dromal stage, a period of excitement and a period of paralysis. 
In the prodromal stage the child becomes irritable and rest- 
less, there is anorexia, headache, pain in the limbs, accom- 
panied by nausea and obstinate vomiting. The second 
stage is marked by an aggravation of the symptoms just 
enumerated, with fever. The headache becomes intense, and 
is usually general. The hydrocephalic cry is usually present. 
Obstinate constipation is characteristic. There is a rapid 
pulse, which may be from 120 to 160 per minute ; the abdomen 
is prominent; nervous symptoms are present, most frequently 
delirium. The pupils are contracted, and strabismus may 
occur. There is marked cutaneous hyperesthesia. Convul- 
sive movements are common. This period lasts for a week or 
ten days and is followed by the stage of paralysis. The fever 
becomes higher, often reaching 105° or 106°. Spasmodic 
contractions, with tremor and twitching of. the tendons and 
muscles, with local paralysis occur. The third nerve is most 
frequently involved, causing ptosis. The duration of the dis- 
ease is variable, lasting about three weeks. When the disease 
occurs in adults it may be prolonged to three or four months. 
Leukocytosis is present throughout the course of the disease. 

What should be done for hemoptysis occurring in the 
course of phthisis? 

Absolute quiet is essential ; food and drink should be stopped 
for a while; ice bags may be applied over the chest; the ad- 
ministration of opium in some form is generally advised. 

Describe the eruption of typhoid fever. 

The eruption in typhoid fever appears about the seventh 
dny. principally upon the abdomen, chest or back, consists of 
slightly elevated, rose-colored spots, which disappear upon 
pressure. The eruption occurs in crops, usually about a 



PRACTICE OF MEDICINE. 27 

dozen, and lasts about three days, when fresh crops appear, 
which last into the fourth week of the disease. 

What is an endemic disease? 

One that is always present in a given community. 
1 Give the symptoms of epidemic influenza. 

The disease occurs suddenly, usually with a chill and marked 
fever, 103° -105°, with catarrhal symptoms, such as sneezing, 
coughing, etc. There is headache, usually frontal or behind 
the eyes, or at the root of the nose, pain in the limbs and in 
the bones. There is marked prostration, out of proportion to 
all the other phenomena. There is a constant tendency to 
complications resulting from inflammation of the respiratory 
or gastro-intestinal mucous membrane. There may be nau- 
sea and diarrhea. Uncomplicated cases last from a week to 
ten days. 

What is hemoptysis? 

Bleeding from the lungs. 

Give the physical signs of pleuritic effusion. 
n On inspection there may be slight bulging. The apex-beat 
of the heart is seen to be displaced. Upon palpation there is 
decreased vocal fremitus. Upon percussion there is flatness 
over the affected area. Upon auscultation the breath sounds 
are absent, and vocal resonance cannot be obtained over the 
affected area. 

Describe the natural heart sounds. 
, Two distinct sounds are encountered: The systolic or first 
sound, and the diastolic or second sound. They are separated 
from each other by a short pause, a long pause occurring 
between the second and first sound. The first sound is due to 
the contraction of the ventricle, the rush of blood and the 
closure of the auriculo- ventricular valve. It is long, low and 
twbming in character. The second sound is due to the closure 
of the semilunar valve, and is short and valvular. The first 
sound is best heard at the apex, the second sound at the base 
of the heart. 



28 PRACTICE OF MEDICINE. 

On what day does the rash usually appear in scarlatina? 

At the end of the first or beginning of the second day. 
What are the symptoms of delirium tremens? 

The prodromes consist of nervousness, restlessness and ano- 
rexia. As a rule there is insomnia. A tremor occurs which 
affects the lips, tongue and limbs. Delirium soon develops, 
which is active and constantly changing. The skin is moist 
and the expression is anxious. The pupils are dilated. The 
temperature is subfebrile, the pulse soft and rapid. The 
tongue is covered with a thick fur, and there is sometimes 
nausea and vomiting. 

What are the clinical features of cerebrospinal fever? 

The onset is sudden, beginning with intense headache, stiff- 
ness in the muscles of the back of the neck, nausea and vomit- 
ing. The attack may begin with a chill. Delirium and stupor 
commonly occur. There is marked alteration of sensation. 
The fever varies from 101° -105° or more. Kernig's sign is 
present. Herpes is very common. Other eruptions also 
occur, such as erythema, urticaria and petechia. Arthritis 
may be present. The urine is scanty and may contain 
albumin. 

Diagnose varioloid. 

The disease begins with a chill, followed by fever of about 
103°. There is nausea and vomiting, pain in the head and 
back. The eruption oecurs earlier than in variola, usually in 
the course of the second day. It is never so copious. The 
evolution of the pox is arrested in the vesicular stage. There 
is no secondary fever, as there is no pus to absorb. 

Give the symptoms of acute myelitis. 

Paralysis of motion, which comes on rapidly, with complete 
loss of sensation below the site of the lesion, and paralysis of 
the sphincters are the important symptoms. Bed-sores usually 
occur. There is some rise in temperature. Convulsions may 
occur. Reactions of degeneration are not present. The re- 
flexes are exaggerated when the lesion is above the lumbar 



PRACTICE OF MEDICINE. 29 

region, and ankle clonns may be elicited. Loss of sensation 
is complete. 

What diseases produce conditions of the skin which are 
of general diagnostic value? 

The eruptive diseases, yellow fever, diseases of the liver, 
purpura, Addison's disease and melanotic cancer. 

What would auscultation and percussion reveal in a case 
of congestion of the lung? 

Auscultation would reveal small moist rales, with broncho- 
vesicular breathing; percussion may reveal impairment of 
resonance. 

What are the physical signs of stenosis of the mitral 
valve? 

A presystolic murmur heard at or near the apex, which is 
not transmitted, a presystolic thrill and a rapid, irregular, 
feeble pulse. 

Describe the features of a case which would lead you to 
diagnose acute appendicitis. 

Marked tenderness and pain in the right iliac fossa, espe- 
cially over McBurney's point; rigidity upon the affected side; 
nausea and vomiting, and marked constipation. 

What does the urine reveal as to color, specific gravity, 
quantity voided, abnormal constituents, etc., in a typical 
case of diabetes mellitus? 

The color is pale yellow with a slight greenish cast ; the spe- 
cific gravity is high, 1030 or over ; the quantity voided is usu- 
ally large, five quarts or more in twenty-four hours; the 
abnormal constituents consist in the presence of glucose; 
occasionally there is also albumin. 

State the sex and period of life to which chlorosis is 
confined. 

It is common in the female sex, rarely occurring in the male. 
It is usually at the age of puberty. 



30 PRACTICE OF MEDICINE. 

What are the grades of temperature which come under 
observation in the sick? 

The temperature of collapse is below 96°; subnormal tem- 
perature is from !H)°-97.5° ; normal temperature is 98.6° ; a 
subfebrile temperature is from 99.5° to 101° ; moderate fever 
from 101° to 103°; high fever from 103° to 105°; hyper- 
pyrexia above 105.5°. 

Give the most frequent causes of pericarditis. 

The most frequent causes are rheumatic fever, scarlet fever, 
diphtheria, septicemia and trauma. 

Give the symptoms of an ordinary case of scarlet fever. 

The disease begins suddenly, Avith chill or a convulsion. 
There is nausea and vomiting, high temperature, rapid pulse, 
and marked angina. There is enlargement of the lymphatics 
at the angle of the jaw. At the end of the first or beginning 
of the second day an eruption appears all over the body, which 
has the color of a boiled lobster. The eruption lasts four to 
iive days and disappears by desquamation. Postscarlatinal 
nephritis is a frequent complication. 

Describe an attack of acute articular rheumatism. 

The disease begins suddenly, with fever of about 102°-103°. 
There is pain, tenderness, swelling and redness in one or more 
of the large joints. Occasionally prodromes are present. 
There may be a preceding tonsillitis or pharyngitis. The 
involvement of the joints is symmetrical. The pulse is accel- 
erated from 100 to 110 per minute, the urine is high-colored, 
scanty ii&> amount, specific gravity from 1025 to 1040, contain- 
ing an abundance of phosphates and urates, albumin being 
rarely I present. The saliva is strongly acid. Copious acid 
sweats occur. Skin eruptions are common, such as urticaria 

and erythema. . . _. r 

8i 8180101 rn rtomw oi stiI to bon^q brm /.^x snJ 

What abnormal organic ingredients are found isi?tlifc 

urins Intqlfijronlf.^rj^^'s disease? 

Albumin and tube casts, -rhod.nq % si tl 



PRACTICE OF MEDICINE. 31 

Give the differential diagnosis between cerebrospinal, 
meningitis and typhoid fever. 

In the first week of the disease the diagnosis is often diffi- 
cult. Later in enteric fever the characteristic eruption ap- 
pears, the spleen enlarges, the pulse becomes dicrotic, the 
nervous symptoms are not prominent until the beginning or 
toward the end of the second week, the headache disappears 
at the end of the first week, the Widal reaction is present. 
In enteric fever the onset is rarely sudden ; there are marked 
prodromes, such as headache, epistaxis; vomiting is very in- 
frequent; the temperature curve in enteric fever is charac- 
teristic, rising step-like in the first week, being subcontinuous 
in the second, remittent in the third and intermittent in the 
fourth week. The onset in cerebrospinal fever is sudden, 
with chill or convulsion • marked rigidity of the muscles of the 
back of the neck; violent headache and marked vomiting of 
the cerebral type. Herpes is common. The temperature is 
not characteristic, and the nervous symptoms are much more 
prominent than in enteric fever. 

What are the physical signs of pulmonary solidification? 

Upon palpation there is increased vocal fremitus. Uppp 
percussion there is dulness, and upon auscultation there is 
bronchial breathing. There may be rales. 

Differentiate catarrhal from croupous pneumonia. 

Catarrhal pneumonia is a disease secondary to bronchitis. 
Croupous pneumonia occurs suddenly, with marked chill, high 
temperature. In croupous pneumonia there is marked pain 
in the side, cough, anxious expression of the face, flush upon 
the cheeks, herpes, rusty sputum, and the disease terminates 
by crisis, usually upon one of the odd days of the disease, 
fifth, seventh or ninth day. Bronchopneumonia occurs most 
commonly at the extremes of age. The disease is longer in 
duration, terminating by lysis. Upon physical examination 
in bronchopneumonia there are scattered areas through bo'th 
lungs, over which may be detected subcrepitant rales ,aiid) 



arjoj 



32 PRACTICE OF MEDICINE. 

ease affecting the base of the lung. The crepitant rale, which 
occurs in the first stage, disappears in the second stage and 
reappears in the third stage as crepitus redux, is charac- 
teristic. 

Give the general symptoms of cerebral hemorrhage. 

The onset is sudden, with loss of consciousness, a rapid 
development of hemiplegia, conjugate deviation of the head 
and eyes, usually normal temperature, full, bounding pulse 
and irregular pupils. There may be Cheyne-Stokes respi- 
ration. 

What condition of the blood is generally prominent in 
all forms of rheumatism? 

There is marked anemia. The red bloodcells may be re- 
duced one-half or more in number. The hemoglobin may be 
reduced to fifty per cent., and leukocytosis occurs. 

Where is the aortic regurgitant murmur most distinctly 
heard? 

At the second right costal cartilage, and transmitted down 
the sternum. 

What adventitious sounds are usually discovered by 
auscultation in catarrhal pneumonia? 

Rales, usually of the subcrepitant variety, large mucus 
rales and bronchovesicular breathing. 

How are the lymphatic glands involved in scarlatina? 

The lymphatic glands at the angle of the jaw and of the 
neck are usually enlarged, sometimes greatly, so that they 
form what is known as the collar of brawn. 

Give the physical signs of the second stage of acute lobar 
pneumonia. 

There is dulness on percussion, bronchial breathing on aus- 
cultation. 

Give the topographical outlines of the liver as revealed 



PRACTICE OF MEDICINE. J 33 

by percussion when the patient is in the recumbent posi- 
tion. 

Anteriorly liver dulness begins in the mammillary line at 
the sixth rib, in the axillary line at the eighth rib, and in the 
scapular line posteriorly at the tenth rib. It extends from 
all these points to the lowest border of the costal cartilages. 

At what point does auscultation best reveal the sound 
of the mitral valves and of the aortic valves? 

The sound of the mitral valve is best heard at the apex of 
the heart. The sound of the aortic valve is best heard at the 
second right costal cartilage near the sternum. 

Make a diagnosis of locomotor ataxia. 

The disease is commonly divided into three stages : The pre- 
ataxic, the ataxic and the paralytic stage. The pre-ataxic 
stage is characterized by lightning pains, most often in the 
lower extremities, by ocular phenomena, such as the Argyll- 
Robertson pupil, which is a contracted pupil reacting to 
accommodation but not to light, and by the use of the patellar 
tendon-reflex. In the second stage the ataxic gait occurs ; the 
patient cannot stand with his feet in juxtaposition with his 
eyes closed.. The symptoms of the pre-ataxic stage continue 
in this stage. The paralytic stage is characterized at first by 
loss of control of the sphincters and by paralysis. 

Give the symptoms of acute spinal meningitis. 

The disease usually begins with chill and a temperature of 
the aseptic type. There is severe pain in the back, increased 
by motion, radiating into the extremities ; rigidity of the mus- 
cles occurs. Hyperesthesia is general. The reflexes are ex- 
aggerated, and ankle clonus is pronounced. There may be 
retention of urine and feces from paralysis of the sphincters. 

What is the period of desquamation in scarlet fever? 

The period of desquamation in scarlet fever usually occurs 
after the appearance of the eruption, or when the eruption 
has been prominent for about four or five days. It may last 
3 



34 PRACTICE OF MEDICINE. 

from several days to several weeks or more. The desquama- 
tion is usually in large scales. 

Define lithemia 

A condition due to a disturbance of metabolism, character- 
ized by an excess of uric acid in the blood, and clinically by 
various digestive, nervous and circulatory phenomena. 

What are hemic murmurs as applied to the heart, and 
what is their cause? 

It is commonly believed that hemic murmurs are due to an 
alteration in the constituents of the blood, such as occurs in 
chlorosis or in other forms of anemia. These murmurs are 
systolic in time, soft, and heard at the left base of the heart. 

Make a general diagnosis of icterus. 

Jaundice is characterized by a yellowish discoloration of 
the skin and of the conjunctiva. There is itching of the skin, 
slow pulse, the appearance of bile pigment in the urine and 
clay-colored stools. 

Why is dyspnea caused by disorganization of the mitral 
valves? 

This is due largely to the fact that, when rupture of com- 
pensation occurs, the right heart, and hence the pulmonary 
circuit, is interferred with. 

Describe a typical case of laryngismus stridulus. 

The disease comes on abruptly, the child being attacked 
most often at night with shortness of breath, followed by clos- 
ure of the glottis, which may remain closed from several sec- 
onds to twenty or thirty. During this time cyanosis may be 
a prominent feature. This is followed by relaxation of the 
spasm giving rise to high-pitched inspiration. Convulsions 
may occur, and are apt to be very severe. 

Describe a typical case of typhus fever. 

The disease begins suddenly, with marked chill and high 
temperature. There is nausea, vomiting and epigastric pain. 
The pulse is rapid, hard and not easily compressible. Ver- 



PRACTICE OF MEDICINE. 35 

tigo and delirium soon set in. The face is reddened, the pupils 
are contracted and the conjunctiva injected. The tongue is 
coated. The liver and spleen are painful upon palpation 
and are somewhat enlarged. Delirium and convulsions are 
common. Constipation is marked throughout the course of 
the disease. On or about the fifth day an eruption occurs, 
which, in its early appearance, closely resembles measles. It 
occurs all over the body except the face. This eruption after- 
ward becomes petechial. Another eruption is characteristic, 
which consists of marbling or mottling of the skin. On or 
about the fourteenth day of the disease crisis occurs. 

What is the significance of prolonged expiration? 

When inflammatory exudates occur in the bronchial tubes 
the expiratory murmur equals and occasionally is longer than 
the inspiratory murmur. AVhen this sign is localized to the 
apices it is indicative of incipient tubercular disease. It fur- 
ther occurs in bronchial asthma and in chronic pulmonary 
emphysema. 

What age and sex are most subject to chorea? 

It is a disease of childhood, most common between the fifth 
and fifteenth years ; much more common in the female than in 
the male sex. 

Whzt ts understood by an exanthematous fever? 

A fever in which a characteristic eruption occurs. 

What parts of the brain are most liable to hemorrhage? 

The parts supplied by the middle cerebral artery. 

What are the three prominent symptoms or conditions 
usually characteristic of exophthalmic goiter? 

Exophthalmus, enlargement of the thyroid gland and tachy- 
cardia, besides which tremor is also pronounced. 

Describe the morbid states associated with asthma. 

They are chronic bronchitis and chronic pulmonary emphy- 
sema. 



36 PRACTICE OF MEDICINE. 

Give the more common causes of chorea. 

Childhood ; female sex ; it is more common in the temperate 
climate; most prevalent in the spring months; acute rheu- 
matic fever has been given as the exciting cause in over twenty 
per cent, of the cases. Fright, shock and worry have been 
mentioned as predisposing factors. It may result from reflex 
causes, such as intestinal worms, eye-strain, nasal disease and 
sexual disorders. 

What are the general or constitutional! symptoms of 
diphtheria? 

The onset of the disease is rapid, the early symptoms being 
discomfort and weakness, with headache. There is moderate 
fever. Pain on swallowing is often the first symptom. Upon 
examination of the throat the characteristic exudate is seen. 

What are the physical signs of aortic regurgitation? 

Upon inspection the apex of the heart is found displaced 
downward and to the left. The impulse is seen to be forcible, 
indicating great hypertrophy of the left ventricle. Palpation 
confirms this. Upon auscultation a diastolic murmur is noted 
at the second right costal cartilage, transmitted down the 
sternum. The Flint murmur may be present. The pulse is 
characteristic, being known as Corrigan, receding or water- 
hammer pulse. 

On what day does the rash usually appear in measles? 

On the fourth day. 

What is progressive pernicious anemia? 

This is a primary anemia, characterized by a marked de- 
crease in the number of red bloodcells, by fatty degeneration 
of the heart, liver and kidneys, and by a peculiar lemon-yellow 
discoloration of the skin. 

What is Asiatic cholera? 

A specific disease, due to the comma bacillus of Koch, pre- 
vailing endemically in some parts of the world, and occasion- 
ally becoming. epidemic, characterized by vomiting, purging, 
muscular cramp and high mortality. 



PRACTICE OF MEDICINE. 37 

In auscultation of healthy lungs what sound is heard 
and what is it technically termed? 

The breath sound is heard, and in an expiration it is known 
as normal vesicular breathing. 

What are the diagnostic points in secondary syphilis? 

The eruption upon the skin, mucous patches and the falling 
out of the hair. Occasionally syphilitic fever is present. 

Enumerate the points of diagnostic value in a case of 
chronic interstitial nephritis. 

Hypertrophy of the heart and arteriosclerosis, albuminuric 
retinitis, headache, the passage of large amounts of urine of 
low specific gravity, 1004 to 1006, traces of albumin and often 
without albumin, and the presence of tube casts. 

Name a medicine which affects the urine as to color and 
odor. 

Turpentine. 

What cardiac lesions are likely to accompany or to fol= 
low acute articular rheumatism? And how may they be 

recognized by the aid of the stethoscope? 

Pericarditis and endocarditis. In endocarditis a murmur 
will be developed ; in pericarditis a friction sound is heard. 

Mow may rheumatism affect the respiratory organs? 

Pleurisy with or without effusion may occur in the course 
of rheumatic fever. 

What is the usual reaction of the urine in (a) chronic 
cystitis, (b) acute articular rheumatism? 

In chronic cystitis the reaction is usually alkaline; in acute 
articular rheumatism markedly acid. 

Describe the mitral regurgitant murmur. Give the to= 
pography of the chest, showing where this sound is best 
heard. 

The mitral regurgitant murmur is best heard at the apex of 
the heart. It is systolic in time and transmitted to the angle 
of the scapula through the left axilla. 



38 PRACTICE OF MEDICINE. 

What is the diagnostic significance of dropsy? 

Dropsy is an accumulation of vatery fluid in one or more 
of the serous cavities or in the subcutaneous tissues. It is due 
to venous obstruction, to a toxemic condition of the blood, to 
the effects of inflammation upon the neighboring circulation, 
to vasomotor causes relating to disease of the nervous system, 
to lymphatic obstruction, and it occurs in a condition known 
as idiopathic or essential edema 

Define a puerile murmur and give its causes. 

This form of breathing is normal in infants and children. 
It diminishes in intensity up to the age of twelve years. It 
closely resembles bronchovesicular breathing. However, the 
ratio between the length of inspiration and expiration is 
always longer. It is occasionally heard in dyspnea, especially 
from disease of the heart. It also occurs in what is known 
as compensatory breathing over one lung when there is disease 
of the opposite lung, or in the portion of one lung when it is 
affected by disease in another part. 

Differentiate between sibilant and sonorous ralei. 

Sibilant rales are high-pitched, whistling rales, and o?cur 
in the smaller bronchial tubes. Sonorous rales are low 
pitched, snoring in character, and they occur in the larger 
bronchial tubes. 

Name the leading rational and physical signs of chronic 
bronchitis. 

The important sign of chronic bronchitis is cough, with or 
without expectoration. After chronic bronchitis has existed 
for some time, emphysema frequently occurs, and also bronchi- 
ectasis. The physical signs which belong to chronic bron- 
chitis are, particularly, rales, which are dry rales if there be 
no expectoration, and moist rales if expectoration be proiuse. 

Differentiate between pulmonary edema and pneumo- 
nitis. 

Pulmonary edema is usually a secondary disease. There is 
marked dyspnea, urgent and troublesome cough, large num- 



PRACTICE OF MEDICINE. 39 

bers of moist rales of all sizes are heard, particularly at the 
base. In pneumonitis there is the onset, with chill, high tem- 
perature, rusty sputum, and the important physical signs, 
which consist in crepitant rales, followed by bronchial breath- 
ing, and the crepitus redux. The termination is by crisis. 

In what conditions does bronchial breathing take the 
place of vesicular breathing? 

Bronchial breathing is encountered over airless spaces in 
the lung tissues and over cavities. Only pulmonary tissues 
containing air have the property of changing into the vesi- 
cular murmur the bronchial sound as it passes through the 
trachea and bronchi. 

What is the character of the fever curve in chronic 
tuberculosis? 

As a rule it is intermittent in character. Occasionally, 
however, the inverse temperature curve is seen. 

What are the physical signs in the first stage of pneu= 
monic fever? 

On inspection there is increased breathing;, palpation may 
detect friction fremitus from the associated pleurisy. On 
percussion there is impairment of resonance, and on auscul- 
tation the crepitant rale is found to be present. 

Relate the history of a case of progressive muscular 
atrophy. 

The early symptoms are pain in the arm and shoulder, with 
numbness and a feeling of exhaustion; next, atrophy is no- 
ticed, as a rule, in one hand. The wasting usually extends 
and the muscles supplied by the ulnar nerve are, as a rule, 
most affected. The motion of the fingers becomes impaired, 
and the wasting gradually passes up from the forearm to the 
arm and shoulder. Both flexors and extensors are affected. 
The other hand usually shows the same process within two to 
ten months. Sometimes the muscles of the shoulder are first 
affected, next the muscles of the back, hip and thigh are in- 
volved. It is rare for the muscles of the legs to be attacked. 



40 r PRACTICE OF MEDICINE. 

There is paralysis and fibrillary twitching. The reflexes are 
lost early. Reactions of degeneration set in later. One or 
both sides cf the face may be affected. The sphincters do 
not share in this process. 

Describe chronic alcoholism and some of its effects. 

As a rule, the onset is insidious, the symptoms consisting in 
fatigue, unwillingness to work and loss of energy. There is 
malaise, headache, general and mental depression, loss of sleep 
and tremor of the hands, lips and tongue. The tremor at first 
may be controlled. As the condition advances these symptoms 
become more manifest. The skin becomes flabby, the face shows 
venous congestion, and acne may show itself about the nose. 
Symptoms of gastric catarrh are present as a rule. The 
tongue is flabby and furred, and the tremor is marked when 
the tongue is protruded. Leukoplakia may occur, especially 
in males. The breath is fetid, and there is great thirst. 
Often there is disgust for food, especially in the morning, and 
this is aggravated by the early morning nausea and vomiting. 
Insomnia is an early and almost constant symptom, and if the 
patient sleep at all, he is disturbed by bad dreams. Peri- 
pheral neuritis may develop. The will and intellectual facul- 
ties are greatly impaired, and there is perversion of the moral 
tendencies. The resistance of the body becomes lessened, so 
that drinkers readily succumb to the acute infectious diseases. 

What is the diagnostic significance of Cheyne=Stokes 
respiration? 

This form of respiration is very likely to be observed in 
diseases of the brain, from disturbances of the circulation or 
from toxic conditions. 

State where topographically mitral and tricuspid mur- 
murs are most distinctly heard. 

The mitral murmur is heard at or near the apex. The tri- 
cuspid murmur is heard a little to the right of the ensiform 
cartilage. 



PRACTICE OF MEDICINE. 41 

Enumerate the diagnostic sounds in a diseased respi- 
ratory apparatus. 

There may be moist or dry rales, crepitant rales, friction 
sounds, bronchial breathing, bronchovesicular breathing or 
cavernous breathing. 

In what conditions does sub=normaI temperature occur? 

This occurs in diabetes, myxedema, chronic cardiac, renal 
and hepatic disease, and in many forms of insanity. It is 
also common in internal malignant growths. It frequently 
occurs after the defervescence in some of the specific fevers. 
It occurs in the stage of collapse in cholera. 

Describe leukemia. 

Leukemia is a disease in which the white blood corpuscles 
are greatly increased in number ; the percentage of the various 
forms also differ widely from the normal. It is characterized 
anatomically by changes in the spleen, lymphatic glands or 
bone marrow, singly or combined. 

How does paralysis of the third nerve affect the eye? 

There may be ptosis, slight exophthalmus, external stra- 
bismus, diplopia and a dilated pupil which reacts neither to 
accommodation nor to light. 

Give the causes and clinical features of purpura sim= 
plex. 

This condition occurs in many diseases. It is characterized 
by the extravasation of blood into the skin, mucous membranes 
and internal organs, and sometimes by free hemorrhage from 
mucous membranes. The alterations in the composition of 
the blood in purpura are usually those of symptomatic ane- 
mia from hemorrhage. Purpura simplex is most usually 
met with in children. It is a mild condition, accompanied 
with purpuric spots upon the extremities, and sometimes 
upon the trunk and arms, with impairment of the appetite 
and diarrhea. 

Make a diagnosis of cerebral tumor. 

The characteristic symptoms consist in headache, optic 



42 PRACTICE OF MEDICINE. 

atrophy, sensory disturbances, convulsions, vomiting, vertigo 
and bradycardia. The headache is almost constant, and in- 
creases in severity as the disease advances. It may often be 
diffuse, occupying the entire skull. Double optic neuritis is 
very frequent. The temperature is usually normal or sub- 
normal. If, however, the tumor be situated in the pons or 
medulla there may be hyperpyrexia. Occasionally there is 
dyspnea, and also Cheyne-Stokes lespiration. Yawning and 
hiccough occur. 

Describe the skin appearances in (a) rubeola, (b) ru= 
bella, (c) scarlatina and (d) varicella. 

(a) In rubeola the eruption appears upon the fourth day. 
It is maculo-papular and coarse. It appears all over the body, 
and is particularly marked upon the face. It is sometimes 
arranged in crescentic form. It disappears by fine desqua- 
mation, (b) In rubella the eruption occurs upon the first day 
irregularly over the face, neck, chest, body and limbs. It is 
a multiform eruption, and may resemble erythema, urticaria, 
and in some cases even measles and scarlet fever. It may be 
confluent or diffuse, and usually lasts from two to four days. 
Desquamation occurs in fine scales, (c) In scarlatina the 
eruption appears at the end of the first day or beginning of 
the second day. It is a bright scarlet eruption, being a true 
inflammation of the skin. It disappears by desquamation, 
which is often in large scales, an entire cast of a hand or foot 
coming away, (d) The eruption in varicella appears upon 
the first day, the exanthem showing itself as small reddish 
points or papules, which in a few hours become vesicles. The 
eruption is slightly elevated above the skin, rather than hav- 
ing the appearance of being under the skin. The vesicles are 
thin and transparent, and from % to 14 of an inch in diam- 
eter. The contents are at first clear and transparent. As a 
rule there is no areola. In the course of a few hours the vesi- 
cle becomes milky, and begins to shrivel. Tie pox may appear 
upon the face, neck, scalp, and some parts of the trunk. 

In what diseases may blood be expectorated? 

As a rule it occurs in chronic pulmonary tuberculosis. It 



PRACTICE OF MEDICINE. 43 

sometimes occurs in croupous pneumonia. It may result from 
cancer of the lungs, from abscess of the lung, from bronchi- 
ectasis, ulcerative lesions of the bronchi and frequently in dis- 
ease of the mitral valve. It may occur from aortic aneurysm. 
Malignant disease and parasites of the lung also give rise to 
it. Vicarious hemorrhage (?). It may occur in the hemor- 
rhagic diathesis, in purpura and trauma of the chest wall. 

Give the period of incubation and of eruption of the 
exanthemata. 

The period of incubation in scarlet fever is from four to 
seven days. The eruption occurs at the end of the first or 
beginning of the second day. The period of incubation in 
measles is about ten days. The eruption occurs on the fourth 
day. The period of incubation of rubella is about eighteen 
days. The eruption appears upon the first day. The period 
of incubation in variola is from ten to thirteen days. The 
eruption appears upon the third day. The period of incu- 
bation of varicella is from ten to fifteen days. The eruption 
appears upon the first day. 

Make a differential diagnosis between renal colic and 
hepatic colic. 

The pain in biliary colic radiates over the upper half of the 
abdomen toward the right shoulder. There is tenderness over 
the gall-bladder. The pain in renal colic radiates less over 
the abdomen, but is marked down the ureter to the testicles 
and to the head of the penis, often irritating the rectum. 
There is tenderness over the kidney and in the lumbar region. 
In biliary colic the vomiting is pronounced and persistent. 
In renal colic vomiting may be present, but is never persistent. 
In biliary colic there are no symptoms relating to the bladder 
or testicle. In renal colic these symptoms are marked. The 
urine may contain bile in biliary colic. In renal colic the 
urine may contain blood and mucus. Jaundice is present in 
biliary colic, and entirely absent in renal colic. 



44 PRACTICE OF MEDICINE. 

Mention and describe, in regard to the feces, abnormal 
conditions that are of diagnostic value. 

Large quantities of mucus may be present in the evacua- 
tions, showing a catarrhal condition of the mucous membrane 
of the intestine. Fat may occur in the stools, and be due to 
disease of the pancreas. Blood occurs from hemorrhage in 
the intestine. Pus may occur from the rupture of an abscess 
situated anywhere in the intestinal tract. Gall-stones and 
enteroliths are also diagnostic. Shreds of tissue and fibrinous 
casts from necrosis occasionally occur. They may be due to 
carcinoma of the bowel. Fibrinous casts occur particularly 
in the course of dysentery. Various forms of animal para- 
sites may also be found in the stools. 

Give the symptomatology of epilepsy. 

As a rule the attack comes on suddenly, the patient falling 
to the ground unconscious. This may or may not be preceded 
by an aura. At first there are tonic spasms, the patient often 
biting his tongue and bloody foam appearing at the mouth. 
This is followed by clonic spasm, and this in turn is succeeded 
by epileptic coma. During the attack the pupils are markedly 
dilated. After the attack the patient usually falls into a 
deep, profound sleep lasting for several hours. 

Outline the area of normal liver dulness. 

Anteriorly liver dulness begins in the mammillary line at 
the sixth rib, in the axillary line at the eighth rib, and in the 
scapular line posteriorly at the tenth rib. It extends from 
all these points to the lowest border of the costal cartilages. 

Make a diagnosis of infantile spinal paralysis. 

The disease begins suddenly, often with convulsions, de- 
lirium and fever. The temperature rises suddenly, usually to 
about 103° F., there is pain in the back and limbs, and some- 
times diarrhea. Paralysis, as a rule, occurs suddenly. The 
paralysis is more extensive early, and the muscles of the par- 
alyzed limb soon undergo atrophy. Reactions of degenera- 



PRACTICE OF MEDICINE. 45 



tion are marked. The legs are most often attacked. Later, 
as a rule, marked improvement takes place. 

How may pleuritic friction sounds be distinguished from 
rales occurring in the bronchial tubes? 

A friction sound is close to the ear ; it is distinctly localized, 
and accompanied by pain on respiration. It may occur in 
inspiration or in expiration or be heard in both. As a rule 
there is no pain with rales ; they are further from the ear and 
are more diffused over the chest. 

What complication should be guarded against in inflam- 
matory conditions of the ear? 

The most important complication relates to an affection of 
the meninges. This is more apt to result from disease of the 
middle ear. 

Define cyanosis and give its causes. 

This is a blue-red condition of the skin, showing itself most 
prominently upon those parts that are normally bright red, 
such as the lips, cheeks, mucous membranes and the finger 
nails. Cyanosis is due to the accumulation of carbonic acid 
in the blood and a deficient amount of oxygen, the blood hav- 
ing a venous or hypervenous character. 

What aids to diagnosis are utilized in the treatment of 
persons affected with stomach lesions? 

Inflation of the stomach may be practiced so as to determine 
the size and position of the stomach. The X-ray may be used. 
A test meal may be given, and the contents of the stomach 
withdrawn after a certain time. The contents are then tested 
for free HC1, pepsin, lactic acid, etc. 

State possible causes of dropsical conditions of the abdo= 
men and lower extremities. 

This is most often due to disease of the heart, kidneys and 
liver. It occasionally occurs from profound anemia, and may 
be due to pressure in the abdomen, as from malignant disease 
or aneurysm. 



46 PRACTICE OF MEDICINE. 

What causes generaB anemia? Make a diagnosis of 
general anemia. 

By the term anemia is meant a deficiency of the blood, 
either in its bulk or in certain of its constituents. It is usually 
divided into primary and secondary anemia. By the term 
primary — also called essential, idiopathic or cryptogenetic — 
anemia is meant a disturbance of the blood or blood-making 
organs, so that the anemia seems the distinctive feature of the 
disease, while other symptoms appear mainly dependent upon 
this change. Secondary anemia is due to some disease acting 
upon the blood or blood-making organs, the anemia not being 
the prime feature, but a symptomatic manifestation. The 
diagnosis depends upon a change in the blood itself, either in 
a diminution in the hemoglobin or in the number of blood 
corpuscles, or a change in both these constituents. There are 
also constitutional symptoms, such as pallor, shortness of 
breath, especially upon exertion, digestive disturbances and 
nervous symptoms. 

Mention and differentiate the species of tenia. 

In man three species of tapeworm which are fully developed 
commonly occur. The tenia echinococcus occurs only in its 
larval form. The three varieties are tenia solium, tenia 
saginata and the bothriocephalus latus or tenia latus. The 
tenia solium is sometimes called the armed tapeworm, as the 
rosiellum is supplied with two rows of booklets, each row 
containing from twelve to fourteen hooklets. The head is 
quadrilateral, being supplied with four suctorial discs. The 
worm is about four meters long. The segments are from 6-8 
mm. in breadth and from 10-12 mm. in length. In the tenia 
saginata the head is surrounded by four suckers, with a rudi- 
mentary sucker in the middle. The segments measure from 
8-10 mm. in width and are about 18 mm. in length. In the 
tenia lata the worm varies from 5-16 meters in length. The 
head is elongated, and supplied with two grooved suckers, one 
on each side. The breadth (1.8 cm.) of the joints is greater 
than the length. The mature segments show a rosette ar- 
rangement of the uterus which is characteristic. 



PRACTICE OF MEDICINE. 47 

What is dysphagia, and with what pathological condition 
is it associated? 

Dysphagia is difficulty or pain in swallowing. It may be 
due to causes in the mouth and fauces, such as glossitis, cancer 
of the tongue, to various forms of stomatitis, tonsillitis and 
pharyngitis. Some of the exanthemata, such as scarlet fever 
and variola, give rise to lesions of the throat, diphtheria, 
spasm or paralysis of the pharynx, disease of the larynx, dis- 
ease of the esophagus, such as stricture, cancer, etc. Finally, 
from pressure from the outside, such as from an enlarged 
thyroid gland, thoracic aneurysm, mediastinal tumor, etc., 
and from pleural and pericardial effusion. 

How would aneurysm of the abdominal aorta affect the 
dorsalis pedis artery purse as compared with the radial 
pulse? 

The puke of the dorsalis pedis artery compared with the 
radial pulse would be small and delayed. 

What conditions predispose to cerebral hemorrhage? 

Heredity is important; many individuals inherit the apo- 
plectic constitution. It is a disease of middle life, and more 
common in the male sex. Diseases of the blood vessels are 
important factors. It may follow the infectious fevers and 
diseases producing disturbances of the blood. Embolism is 
an important factor. Hypertrophy of the heart, exertion or 
excitement frequently cause rupture of the diseased blood 
vessels. 

What are the causes of endocarditis? 

The greatest number of cases are the result of rheumatic 
fever. Chorea is also a cause. The acute exanthemata also 
give rise to it, also pneumonia, erysipelas, sepsis, puer- 
peral diseases, and sometimes gonorrhea. Tuberculosis, gout, 
renal disease and diabetes are etiological factors. Trauma 
has also been given as a cause. It occurs in fetal life. It 
may sometimes be secondary, from extension of the disease 
from the myocardium or aorta. 



48 PRACTICE OF MEDICINE. 

Differentiate between cerebral vomiting and gastric 
vomiting. 

Cerebral vomiting occurs without nausea, often with a clean 
tongue, and is not related to the taking of food. In gastric 
vomiting there is the history of some gastro-intestinal affec- 
tion. The tongue is coated, and there is always considerable 
nausea and much retching. 

Give the characteristic differences between diabetes 
insipidus and diabetes mellitus. 

In diabetes insipidus the urine is of low specific gravity, 
never over 1010 ; there is no sugar present, no itching of the 
skin and genitalia, no hunger, no tendency to the formation 
of carbuncles or boils. In diabetes mellitus the urine is of 
high specific gravity, 1030 and over, sugar is present in the 
urine, there is itching of the skin, great hunger, tendency to 
formation of boils, loss of weight, and frequently an etherial 
odor of the breath. 

Give the cause of vertigo. 

Vertigo occurs in the course of neurasthenia and lithemia, 
from gastric disorders, from arteriosclerosis, valvular disease 
of the heart and aneurysm, from Meniere's disease, from 
reflex causes, such as disease of the eye, nose and larynx. It 
also occurs in many nervous diseases, such as epilepsy, etc. 

Describe pyuria and state its import. 

Pyuria is pus in the urine, and is an important symptom 
in many diseases of the urinary tract, from the kidney to the 
end of the urethra. It is present in urethritis, cystitis, ure- 
teritis, pyelitis and pyelonephritis. Pus may be caused by 
rupture of an abscess in the urinary tract (especially the 
bladder) ; this may occur in salpingitis, abscess of the ovary, 
extra- uterine pregnancy, cysts of various kinds, psoas and 
other forms of abscess, etc. 

Describe leukemia and mention the pathological changes 
occurring in this disease. 

Leukemia is a disease in which the white blood corpuscles 



PRACTICE OF MEDICINE. 49 

are greatly increased in number ; the percentage of the various 
forms also differ greatly from the normal. It is character- 
ized anatomically by changes in the spleen, lymphatic glands 
or bone marrow, singly or combined. In the splenomedullary 
form the spleen is greatly enlarged, and it may weigh ten 
pounds or more. The capsule is thickened, and the surface 
of the organ somewhat irregular. On section it is quite firm. 
The color of the pulp is reddish-brown. Infarcts are common. 
The gross appearance of the blood is altered, occasionally 
being milky in character, the specific gravity is decreased, the 
alkalinity is somewhat diminished, and coagulation is slightly 
retarded. The leukocytes show a great increase in number, 
from 250,000-500,000 or more per cmm. In the lymphatic 
variety groups of lymphglands are enlarged, owing to hyper- 
plasia of the lymphoid cells, and the spleen is slightly increased 
in size. The gross appearance of the blood may show very 
slight change or resemble the variety just described. The leu- 
kocytes are also greatly increased in number, but not to the 
extent that they are in the splenomedullary form. Exami- 
nation of the stained films shows an enormous increase in the 
lymphocytes. 

Give the symptoms indicative of impacted gallstone. 

When the gallstone has become impacted there is an arrest 
of the pain. Jaundice is marked, the urine shows bile pig- 
ments, and the stools are clay-colored. There is hepatic inter- 
mittent fever, sometimes called Charcot's fever. This con- 
sists of high temperature, chills and sweating. While this 
fever is paroxysmal, it does not show the regularity of a 
malarial attack. 

Give the treatment of yellow fever. 

Disinfection of the person and all effects. Strict quaran- 
tine. A mild cathartic may be given at the onset with advan- 
tage. Vomiting and gastric irritability may be treated by 
the administration of carbolic acid, cocaine or broken doses 
of calomel. The fever should be treated by cold applications 
to the head and cold sponging. For the pain opium in some 
4 



50 PRACTICE OF MEDICINE. 

form is useful. Strychnine is valuable as a cardiac tonic. 
For the hemorrhage, opium, ergot and suprarenal extract 
may be administered. 

Outline appropriate treatment for Asiatic cholera. 

Complete isolation of the sick and thorough disinfection of 
all discharges and all articles of clothing are absolutely 
necessary. Efficient quarantine must be established. All 
milk and water should be boiled, and no raw fruit or vege- 
table should be eaten. In the stage of premonitory diarrhea 
it is considered good practice to administer a prompt laxative. 
If there be great pain opium may be given hypodermically. 
Salol and guaiacol carbonate may be given from time to time 
as intestinal antiseptics. In the stage of serous diarrhea the 
patient should be wrapped in flannels and external heat ap- 
plied to the body. If there be cramp, friction of the muscles 
is useful. Fluids should only be allowed in very small quan- 
tities. Enteroclysis should be used in this stage. When col- 
lapse sets in, hypodermoclysis of a normal salt solution should 
be given. Strychnine may be given by the skin, but it must 
be remembered that as absorption is slow accumulation may 
occur. 

What are the causes and treatment of palpitation of the 
heart? 

This may be due to reflex causes, such as disease of the 
stomach, disease of the genito-urinary apparatus, and sexual 
excesses. Toxic causes may give rise to it, such as the abuse 
of alcohol, tobacco, tea and coffee. Gout and anemia are 
productive features, and the condition occurs in inanition and 
marasmus. Finally, it is due to disease of the heart itself, 
such as organic disease, and it is an important symptom of 
exophthalmic goitre. The treatment consists in removing the 
cause, if possible, and is then symptomatic. Rest in the re- 
cumbent posture and an icebag over the heart are useful. 

What are the causes and symptoms of dilatation of the 
stomach? 

The dilatation may be acute or chronic. It may be due to 



PRACTICE OF MEDICINE. 51 

obstruction of the pyloric end of the stomach, such as con- 
genital stenosis, the cicatrices resulting from gastric ulcer, 
and from tumors, the most common being malignant. Motor 
insufficiency of the stomach may give rise to dilatation; this 
may result from overeating or drinking, and frequently occurs 
in beer drinkers. The symptoms are general feebleness, ane- 
mia, emaciation, thirst, scanty urine, sallow and hollowed face, 
flabby coated tongue, pyrosis, chilliness, cyanosis, subnormal 
temperature and nervous symptoms. Pain and vomiting are 
always present. The outline of the stomach may be demon- 
strated by means of the X-ray. 

What is scurvy, how should it be prevented and treated? 

Scurvy is an affection characterized by anemia, by swollen, 
tender and bleeding gums, by manifestations of purpura and 
by great prostration due to improper food. The prevention 
of the condition is due to the use of anti-scorbutic food on 
shipboard or among the army supplies. In the treatment, 
antiseptic mouth washes are of use. Fresh vegetables should 
be administered. Lemon-juice is very valuable, as are also 
bitter tonics. 

Give in detail the treatment of diphtheria. 

The prophylaxis is highly important, the disease being very 
contagious and easily transmitted. The patient should be 
strictly isolated. Efficient disinfection is also necessary. 
The food must be nutritious and easily digested. If the 
patient cannot swallow, rectal alimentation must be resorted 
to. Alcohol is necessary, and must be given freely, even in 
mild cases. The membrane must not be removed. Antiseptic 
and soothing applications are employed ; inhalations of quick- 
lime and steam in all cases in which there is danger of invasion 
of the larynx are useful. Hydrogen dioxide in solution is 
serviceable as a mouth wash. Internally, the tincture of 
chloride of iron may be given in medium doses. Calomel or 
corrosive sublimate in appropriate doses are useful. The 
antitoxin treatment, however, is the most important. The 
dose in individual cases varies; from 3,000 antitoxin units 



52 PRACTICE OF MEDICINE. 

may be given at a dose, but this may be increased in severe 
cases and repeated. In laryngeal cases intubation and trar 
cheotomy may have to be resorted to. 

What is the prognosis of suppurative nephritis secondary 
to cystitis? Outline the treatment of the condition. 

The prognosis is unfavorable, and the treatment is surgical. 

Give the etiology of tubercular peritonitis and the treat= 
ment. 

The disease appears at all ages, but it is more common in 
childhood. Males are more frequently attacked than females, 
and it is more often met with in the negro than in the white 
race. It is also found associated with intestinal or mesenteric 
tuberculosis. The condition may be primary in the perito- 
neum, and may be confined solely to this membrane. A com- 
mon mode of infection is through the intestines ; this may also 
occur through the lymphatics or by extension from the pleura 
or the pericardium. It is often of the miliary variety, but 
also of the chronic ulcerative and chronic fibroid forms. The 
modern treatment of this condition is surgical, the best results 
having been obtained by opening the abdomen and producing 
adhesions. 

Give the prophylactic treatment of gout. 

As nearly as possible a vegetable diet should be adhered to, 
as animal food gives rise to uric acid. Water should be par- 
taken of plentifully. Alcoholic and malt liquors, especially 
the rich, sweet wines, such as port, sherry, champagne, should 
be particularly prohibited. Systematic bathing, regular ex- 
ercise in the open air, avoidance of exposure to cold and damp- 
ness are important. 

At what age is spasmodic croup most common? Give 
the symptoms and treatment of spasmodic croup. 

The disease is most common in children before the age of 
puberty. The attack begins suddenly, most often at night. 
The first indication is usually a hoarse metallic cough, fol- 
lowed by dyspnea. In severe cases the dyspnea is so extreme 



PRACTICE OF MEDICINE. 53 

that cyanosis of the face and extremities occurs. There is 
some elevation of temperature. The cough is unproductive 
at first, but at the close of the attack free expectoration may 
occur. The child should at once be immersed in a warm bath, 
and an emetic promptly given. Inhalations of steam are also 
useful. Between the attacks the child should have tonic 
treatment. 

Give the etiology, duration and prognosis of pertussis. 

It is an infectious disease of early childhood, and common 
between the second and seventh year. The disease usually 
lasts from four to six weeks. The prognosis, as a rule, is 
favorable, the danger being due to complications. 

Describe the treatment of biliary lithiasis. 

The prophylaxis consists in appropriate diet, exercise and 
general favorable hygiene. In women tight lacing should be 
avoided. Warm baths, regular exercise in the fresh air, etc., 
should be recommended. The patient should avoid indul- 
gence in sweet and starchy foods. Constipation should be 
corrected. Massage has been strongly advised. For the 
treatment of the attack hot fomentations should be applied 
over the liver. For the pain hypodermic injections of mor- 
phine give relief. If the condition is not relieved by medical 
means, if the jaundice persist, and especially if symptoms of 
Charcot's fever appear, surgical interference should be re- 
sorted to. 

Give the etiology and treatment of St. Vitus' dance. 

Chorea is a disease of childhood, although it may occur at 
any age. Females are most often attacked, and the disease is 
more common in the temperate climate. It is most prevalent 
in the spring months. Acute rheumatic fever has been noted 
as an exciting cause in a large number of cases. Fright, 
shock and worry are predisposing causes. It may be due to 
reflex causes, such as intestinal worms, eye-strain, nasal dis- 
ease and sexual disorders. The treatment consists in long 
hours of rest, especially in bed. If the child be attending 



~>4 PRACTICE OF MEDICINE. 

school it had better discontinue and remain at home. The 
diet should be simple, meats and highly seasoned foods should 
be excluded. Arsenic, antipyrine, bromide of zinc and qui- 
nine are the most useful drugs. 

Give the etiology, symptoms and treatment of cirrhosis 
of the liver. 

The disease occurs most often in the male sex, and is very 
frequently due to alcohol. In the newborn the affection is 
due to hereditary syphilis. The next most important causes 
are acquired syphilis, malaria and other infectious diseases, 
such as cholera, enteric fever and scarlet fever. Gout and 
rickets also give rise to it. The disease may begin without 
prodromes, except in the case of topers who present a long 
history of gastro-intestinal catarrh. Early in the course of 
the affection there may be some slight enlargement of the 
liver. In the fully established disease the organ is dimin- 
ished in size. Of decided diagnostic import is an early atro- 
phic change in the right lobe of the liver, which in some cases 
can scarcely be felt in the abdomen. Jaundice is absent as a 
rule. The most characteristic symptoms relate to the disturb- 
ance of the circulation in the portal vein, or to the diminished 
function in the atrophied cells of the liver, or they depend 
upon a combination of these two conditions. One of the most 
prominent signs is ascites. Even before this the effect of 
congestion of the mucous membranes of the stomach and 
bowels may be noted by hematemesis and enterorrhagia, which 
occur in the course of this affection. Hemorrhoids occur. 
The spleen is enlarged. The cutaneous veins of the abdomen 
are often greatly enlarged. The urine is diminished in 
amount and is of low specific gravity, frequently reddish in 
color. The temperature is normal or subnormal. The gen- 
eral nutrition suffers greatly, and the patient loses flesh. The 
treatment consists in abstaining from alcohol. Potassium 
iodide and mercury are of use in the syphilitic form. The 
bowels should be carefully regulated, and when ascites be- 
comes prominent, paracentesis abdominis becomes necessary. 



PRACTICE OF MEDICINE. 55 

Give the etiology of tetanus. 

The disease occurs in either sex and at any age. It may 
result from a wound in any part of the body, and sometimes 
without apparent trauma. It occurs most often from wounds 
that are exposed to dirt and filth. The exciting cause is the 
bacillus of tetanus described by Kitasato. 

Give the treatment of sciatica. 

Rest by means of splinting the limb is important. Atten- 
tion must be directed to the cause of the disease. If of rheu- 
matic origin the salicylates are of value. Phenacetine, anti- 
pyrine and other members of the coal-tar group are of value ; 
in severe cases, however, morphine is necessary. Surgical 
measures should only be resorted to after all forms of medical 
relief have failed. 

State the varieties, causes and prognosis of angina pec= 
toris. 

True angina pectoris and pseudo angina pectoris. Occlu- 
sion of the coronary arteries and sclerosis are. important fac- 
tors. The true form occurs after middle life, and in the male 
sex ; the pseudo form occurs most frequently in young women, 
in connection with hysteria and neurasthenia. The prog- 
nosis in the true form is very unfavorable ; in the pseudo form 
it is favorable. 

How should insolation (sunstroke) be treated? 

The treatment of thermic fever consists in the application 
of cold to the surface of the body, preferably in the form of 
an ice bath or ice rubbing. The cold pack is sometimes sub- 
stituted. The bath is commonly continued until the temper- 
ature reaches the normal point. Ice water enemata may also 
be employed. Measures should also be taken to guard the 
heart. For this purpose strychnine, digitalis and alcohol 
are useful. 

Give the treatment and prognosis of erysipelas. 

Cold water should be liberally administered to the patient, 
and cold sponging, especially if the temperature is high, is of 



56 PRACTICE OF MEDICINE. 

distinct advantage. Ice cloths are also the best treatment 
for the eruption. They should be frequently renewed. An 
ointment of ichthyol and lanolin is also used for this purpose. 
The administration of tincture of the chloride of iron in full 
doses is the general method of treating erysipelas. When 
the nervous symptoms become prominent, or if in the aged or 
cachectic, bold stimulation is necessary; alcohol is best for 
this purpose. If the pain be severe morphine should be re- 
sorted to. Antistreptococcic serum may be beneficial, and 
should always be resorted to in malignant cases. 

In simple, uncomplicated cases occurring in those in pre- 
vious good health the prognosis is favorable. The prognosis 
should be regarded as serious when erysipelas occurs as a 
complication of any other malady, or when it results from 
surgical accidents or occurs in the puerperal state. It is 
always serious in alcoholics and cachectics. 

State the etiology and prophylaxis of biliary calculi. 

In a majority of cases they are found in persons of thirty 
and over, and they occur more frequently in the female than 
in the male sex. Catarrh of the bile-ducts and gall-bladder 
may lead to stagnation of bile and to an increase in the amount 
of cholesterine. Farinaceous foods may give rise to the for- 
mation of gall-stones ; in diseases in which nitrogenous food 
is largely partaken of, as in diabetes, gall-stones are rarely 
found. They are formed most frequently in the gall-bladder. 
They may occur in the larger gall-ducts, and, rarely, even in 
the smaller biliary passages of the liver. The prophylaxis 
consists in appropriate diet, exercise and general favorable 
hygiene. In women tight lacing should be avoided. Warm 
baths, regular exercise in the fresh air, etc., should be recom- 
mended. The patient should avoid indulgence in sweets and 
starchy foods. Constipation should be corrected. This may 
best be done by the use of waters, such as Carlsbad. Massage 
has been strongly advised. 

What is chronic hydrocephalus? 

As a rule the child's head begins to increase in size soon 



PRACTICE OF MEDICINE. 57 

after birth, or it may even be greatly enlarged at birth. There 
is irritability and restlessness, and much impairment of the 
general nutrition; the child does not grow as is usual with 
normal children, even though the appetite be good. Mental 
development is tardy, and as a rule the child does not learn 
to walk. Ocular phenomena are present, such as strabismus, 
and occasionally optic atrophy. "Within a few years vomiting, 
coma and convulsions appear. Death usually takes place 
from exhaustion. 

Give the etiology and treatment of anthrax. 

This is a widespread disease in animals, occurring all over 
the world. The affection is conveyed to man as the result of 
the handling of wool or hides, rarely by direct inoculation 
from the bites of insects that have fed on animals that have 
died of the disease. It is a very rare affection in man. Cer- 
tain occupations predispose to it, such as those of stablemen, 
tanners, butchers, shepherds and wool sorters. The exciting 
cause is the bacillus of anthrax. It is important that the 
pustules should be treated surgically, the site of inoculation 
being destroyed by bichloride of mercury, carbolic acid or the 
actual cautery. Constitutional treatment consists in the use 
of quinine, iron, strychnine and alcohol. 

Give the treatment of catarrhal pneumonitis. 

When the temperature becomes high, cyanosis shows itself 
and somnolence is threatened, and a warm bath with cold effu- 
sion to the head is useful. Alcohol is valuable as a circulatory 
stimulant. Inhalations of steam are of value. In strong 
children in whom there is great secretion in the bronchial 
tubes which is brought up with difficulty, emetics may be used 
from time to time, but these should not be continued through- 
out the course of the disease. It is dangerous to administer 
narcotics to young children. Stimulating expectorants, such 
as the salts of ammonia, are often useful. Minute doses of 
strychnine and inhalations of oxygen are of benefit. A mild 
purge at the onset frequently gives great relief. The diet 
should be a light and nutritious one. 



58 PRACTICE OF MEDICINE. 

What is the prognosis as to the cure of epilepsy? Give 
the treatment of epilepsy. 

True epilepsy is an incurable affection. Much may be done 
to diminish the number and severity of the attacks, but a true 
cure is rarely met with. In the treatment it is important to 
relieve the cause if possible. It is best to endeavor to treat 
the epileptic in a colony, in which he may have an out-door 
occupation. The bowels should be regulated, the diet should 
consist of meat sparingly, fruit, cereals and vegetables. The 
best results have been obtained from the use of the bromides. 

What cutaneous diseases may occur as complications of 
saccharine diabetes? 

Boils, carbuncles, erythema, eczema, especially of the geni- 
tals, purpura, cellulitis and gangrene. 

What is hemophilia? How should it be treated? 

This is a disease characterized by a tendency to hemorrhage,, 
which is often uncontrollable, and it is due to a deficiency in 
the coagulability of the blood. The coagulation is retarded, 
and frequently in this condition the blood does not coagulate 
in less than from thirty to fifty minutes. The prophylaxis is 
important ; wounds and operations should be avoided in a per- 
son suspected to be a bleeder. When the bleeding is from a 
free surface and easy of access, compression and rest should 
be tried. Ice, locally, is of value. Calcium chloride and per- 
chloride of iron are recommended by many. Gelatine, collo- 
dion and extract of the suprarenal capsule may be found 
useful when applied to the bleeding surface. Freshly drawn 
blood from a healthy person may be employed as an appli- 
cation. 

Describe the treatment of purulent pleurisy. 

The aspirator should be used, and drainage should be as 
free as possible. If the pus does not flow through the needle 
a surgical operation is necessary. 



PRACTICE OF MEDICINE. 59 

Describe the treatment and prophylaxis of nephrolith= 
iasis. 

The treatment consists in relieving the pain during an 
attack of renal colic, which is best accomplished by a hypo- 
dermic of morphine or by the inhalation of chloroform. Hot 
baths and hot fomentations to the loins are useful. Fluids 
should be freely partaken of. For uric acid calculi, piper- 
azin, urotropin, and the salts of lithia are of value. The 
waters of various mineral springs are valuable, such as Carls- 
bad, Ems, Kissingen. Surgical interference is sometimes 
necessary. 

How should cholera morbus be treated? 

Absolute rest in bed is necessary. Food should be given 
sparingly, and it had better be withheld for some time if 
vomiting be frequent. Sterilized milk and animal broths may 
be administered sparingly. Local sinapisms and hot turpen- 
tine stupes are of benefit to allay vomiting. At the onset of 
the disease it is good practice to give a purge. The remedy 
for the condition is opium in some form. Later in the course 
of the affection bismuth and antiseptics which act on the 
intestinal tract are of value. 

What is the treatment of spasmodic stricture of the 
esophagus? 

Dilatation with the esophagal bougie is of value. Remedies 
to act upon the nervous system and tonics are of use. The 
general hygiene of the patient should be carefully looked 
after. 

Give the treatment of hematemesis. 

Absolute rest in bed. Food and drink should be stopped. 
For the thirst small pellets of ice may be taken in the mouth. 
Opium and ergot hypodermically are the best remedies. 

Describe the treatment of rachitis. 

The child should have the best of food, and if the mother 
cannot nurse it a wet-nurse should be procured. Abundance 
of fresh air and sunshine are essential. Daily warm bathing 



60 PRACTICE OF MEDICINE. 

is necessary. The child should not be encouraged to walk. 
The remedies that have proven most effective are phosphorus, 
cod-liver oil and the syrup of the iodide of iron. 

Give the treatment of ulcer of the stomach. 

Kest in bed is most important, even in the mildest cases. 
Food should be withheld from the stomach for some time, rec- 
tal alimentation being resorted to. Milk is the best food, and 
may be given either hot or cold. External applications over 
the stomach, such as hot poultices frequently renewed, are of 
value. Among the most useful of the many drugs that have 
been recommended is bismuth; this remedy should be em- 
ployed in large doses. Salol, oxide of silver, carbonate of 
soda, carbolic acid and cocaine are also highly recommended. 
If there be great pain opium, and sometimes cannabis indica 
are useful. 

Give the symptoms of (a) acute lead poisoning, (b) 
chronic lead poisoning 

In acute lead poisoning the symptoms may come on in a few 
weeks. Rapid and marked anemia is usually the earliest 
symptom. Constipation, which is followed by excessive diar- 
rhea, vomiting, abdominal tenderness and distension are pres- 
ent. The abdomen, as a rule, is hard and distended. There 
is colic of the severest type over the entire abdomen. The 
paroxysms are of gradual onset and increase in severity. The 
pain is relieved by deep pressure. The temperature, as a rule, 
is subnormal. The symptoms of chronic lead poisoning are 
due to the prolonged absorption of lead in small quantities. 
The anemia may be profound, showing a marked decrease in 
the red blood-cells, with a corresponding decrease in the hem- 
oglobin. There is wasting of the muscles and a peculiar yel- 
low complexion, which, however, is not due to the deposit of 
bile pigment. Along the border of the gums, usually most 
marked under the incisor teeth, is a bluish-black line. Tre- 
mors occur from time to time. There is a metallic taste in the 
mouth, coated tongue, fetid breath, marked dyspepsia and 
obstinate constipation. Lead colic is particularly marked. 



PRACTICE OF MEDICINE. 61 

The pain, as a rule, is more severe in the afternoon and at 
night. Occasionally paroxysmal pains occur in the joints 
without swelling, redness or fever. An important symptom 
is lead paralysis. This most frequently occurs as wrist-drop, 
the extensors being particularly affected. Occasionally cere- 
bral symptoms develop, this condition being known as lead 
encephalopathy. 

Give the treatment of suppurative hepatitis. 

The treatment consists in the early evacuation of the ab- 
scess in suitable cases. Purging with calomel or salts is 
recommended. Opium is best to relieve pain. When the 
septic phenomena are marked, free stimulation should be re- 
sorted to, whiskey and strychnine giving good results. Qui- 
nine is often of use. For the anemia iron and arsenic should 
be administered. The diet should be light and nutritious. 

What is uremia and how should it be treated? 

Uremia is a clinical condition due to acute or chronic dis- 
ease of the kidney or of its conducting apparatus. Depend- 
ing upon whether the symptoms arise rapidly or suddenly or 
whether they are more insidious, the condition is known as 
acute or chronic uremia. In the treatment it is important to 
withdraw the urine. In young subjects with slow pulse and 
high arterial tension bleeding is indicated, and should be fol- 
lowed by hypodermoclysis of a normal salt solution. Intra- 
venous injections of a normal salt solution are often indicated. 
Purging by croton oil and broken doses of calomel is useful. 
For the convulsions, chloral and morphine hypodermically 
are the most reliable agents. Sweating should be induced by 
a hot pack or by some similar method. The administration 
of pilocarpine is accompanied with danger on account of its 
depressing effect upon the heart. 

How should acute nephritis accompanying or following 
scarlet fever be treated? 

Absolute rest in bed is important. It is well to put the 
patient on an absolute milk diet. Some of the alkaline min- 



62 PRACTICE OF MEDICINE. 

eral waters, such as Seltzers and Vichy, may be mixed with 
the milk. Daily sponging with warm water and gentle fric- 
tion of the skin are of use. Calomel in fractional doses is 
useful, which may be followed by a saline, even if there be no 
tendency to constipation. Some of the diuretics may be used, 
such as citrate of potash or benzoate of soda. Iron in some 
form is useful, and Basham's mixture is often administered. 

How should edema of the glottis be treated? 

The treatment is that of dropsy occurring in other parts of 
the body. Surgical treatment, such as scarification, intuba- 
tion, tracheotomy, etc., is often necessary. 

Name one important complication and one important 
sequel of typhoid fever. 

An important complication of typhoid fever is hemorrhage 
from the bowels. An important sequel is phlebitis, which 
most frequently occurs in the left leg. 

Outline a plan of treatment of typhus fever. 

The prophylaxis is of the greatest importance. An abund- 
ant supply of good food, fresh air and free ventilation are 
important. Stimulation is necessary on account of the severe 
prostration. If hyperpyrexia occur the cold bath should be 
resorted to. Strychnine may be necessary as a respiratory 
and cardiac stimulant. Complications are treated as they 
arise. The constipation must be relieved by enemata, and in 
convalescence tonics should be administered. 

Give the treatment of pyelitis. 

The patient must be kept in bed and protected against cold. 
A bland diet should be given and the alkaline mineral waters 
freely used. Application of heat to the renal region should 
be resorted to. Warm baths are grateful to the patient. 
Opium in some form to relieve the pain is necessary. In 
chronic pyelitis astringents are indicated, such as acetate of 
lead. Salol and methylene blue are sometimes found of ben- 
efit. Surgical interference is necessary if hydronephrosis or 
pyelonephrosis is present. 




PRACTICE OF MEDICINE. 63 

Mention the most reliable remedy for pulmonary hem= 
orrhage. 

Rest in bed, abstaining from food and drink, an ice-bag 
applied to the chest, and opinm and ergot. 

What remedies should be used in hemorrhage from 
mucous surfaces? 

Opium, ergot and suprarenal capsule. 

What are the complications and sequelae of whooping 
cough? 

Hemorrhages occur, such as petechias, about the face and 
neck ; epistaxis and hemoptysis may occur ; bronchopneumonia 
is a complication which adds greatly to the gravity of the 
case. Pulmonary tuberculosis is comparatively frequent in 
a considerable proportion of the cases, especially in adoles- 
cents. 

Describe the treatment of paralysis agitans. 

The treatment is purely symptomatic. Occasionally hyos- 
cyamin or hyoscin control the tremor. The general hygiene 
of the patient is to be looked after ; tonics, such as arsenic and 
strychnia, are of use. 

What are the causes of peritonitis? 

The most frequent mode of infection is through the intes- 
tines and from the female generative organs. Various forms 
of ulcer may produce peritonitis, such as the typhoid or tuber- 
cular ulcer. Malignant disease of the intestine may give rise 
to it. It also arises from forms of intestinal obstruction, such 
as volvulus and stricture. The gall-bladder and liver may 
be the sources of infection, and particularly abscesses, and 
syphilitic disease may give rise to it. Obstruction of the 
biliary passages by gall-stones may produce it. The affection 
may arise from the spleen, through an infected embolus. It 
may occur from infective disease of the kidney, from disease 
of the bladder wall, from the prostate and from the urethra. 
Peritonitis occasionally occurs in the course of some of the 
acute infectious diseases, such as erysipelas, acute rheumatic 
fever and septicemia. 



64 PRACTICE OF MEDICINE. 

Name the places where yellow fever is endemic. 

The disease is endemic in the West Indies, parts of the 
Mediterranean coast, South America and Africa. 

What treatment would you recommend for diphtheritic 
paralysis? What is the prognosis? 

Rest, tonics, strychnia, and later, electricity are useful. 
The prognosis in all forms of diphtheritic paralysis is favor- 
able as a rule, except in paralysis of the heart. 

What are the causes and treatment of acute myelitis? 

Exposure to variations of temperature, especially to cold, is 
important. Thus certain occupations predispose, such as engi- 
neers, cabmen, drivers, etc. Gout, rheumatism and certain 
metallic poisons, such as lead, mercury and arsenic, have been 
recognized as etiologic factors. Alcohol may also be a cause. 
Syphilis usually gives rise to the chronic form. Occasionally 
acute myelitis may be secondary, resulting from extension, as 
in abscess, caries or cancer of the spine. Traumatism is per- 
haps the most common cause. The puerperal period and the 
existence of septic conditions have also been noted as causes of 
the disease. In the treatment, counter-irritation by blisters or 
the application of cold are of use in the acute stage, but they 
are contra-indicated after this stage. Precaution should be 
taken not to interfere with the nutrition of the skin on account 
of the great liability to trophic changes. Absolute rest is 
important. Great care must be taken of the bladder. The 
catheter should be carefully sterilized. Electricity is benefi- 
cial late in the course of the disease, and at this time massage 
is also valuable. A warm climate favors improvement. Hy- 
drotherapy has been highly recommended. General tonics 
are of use ; the bowels may be moved by enemata. In syphi- 
litic cases anti-syphilitic treatment is indicated. 

What are the complications and sequelae of scarlet 
fever? 

Diphtheria and nephritis are the most important complica- 
tions, and occur in nearly all severe cases. Endocarditis 



PRACTICE OF MEDICINE. 65 

occurs; less commonly pericarditis. Meningitis, peritonitis, 
pleurisy, with and without effusion, also occur. Among the 
most common sequels are enlarged lymphatic glands, chronic 
joint affection, the hemorrhagic diathesis, monoplegia, hemi- 
plegia, peripheral neuritis, hysteria and anemia. 

On what symptoms would you base a diagnosis of ty=* 
phoid fever? 

Upon the slow onset, with a gradual rise in temperature, 
nose bleed, headache, diarrhea, the occurrence on or about the 
seventh day of the typical eruption, enlargement of the spleen, 
dilated pupils, the Widal reaction, and the dicrotic pulse. 

How should scarlatina be treated? 

Strict isolation is important. The scales during the period 
of desquamation should be carefully collected and burned. 
The diet should be nutritious and easily assimilated. Pure 
drinking water or the alkaline mineral waters may be freely 
administered. Milk is a necessary article of diet. There is 
no specific treatment. A mild laxative should be given at the 
onset. Tepid sponging, at least twice daily, is necessary in 
severe cases. Warm bathing is usually very grateful to the 
patient. During the period of eruption an animal fat, used 
as an inunction to the skin, prevents itching and hastens des- 
quamation. A mild diuretic may be used, and it is important 
to keep the kidneys active. Complications must be treated 
upon general principles. 

What should be done for a patient during the passage of 
a biliary calculus? 

Hot fomentations should be applied over the lower part oi: 
the liver. If the pain is severe, whiffs of chloroform may be 
inhaled. However, in the majority of the cases relief of the 
pain only follows the hypodermic use of morphine. If the 
condition is not relieved by medical means surgical interfer- 
ence must be resorted to. 

How should small=pox be treated? 

Vaccination should be practiced as a prophylaxis. Com- 



66 PRACTICE OF MEDICINE. 

plete isolation and disinfection are absolutely necessary. 
There is no specific treatment. Food is not well borne at firs!, 
and there may be much vomiting and diarrhea. Usually acid 
drinks or small particles of ice are grateful to the patient. 
From the onset of the disease detergent washes containing 
antiseptic solutions should be used for the mouth. The room 
should be darkened; the solar light being rigidly exclude:!. 
This prevents pitting. Warm baths two or thiee times 
daily are of decided benefit to the patient. During tli< j 
time of secondary fever bold stimulation is necessary. At 
the onset a laxative is useful. Pain should be overcome by 
small doses of opium, but great care must be exercised with 
this drug, as it tends to lock up the secretions. Restlessness 
and insomnia should be treated by trional and sul phonal. In 
convalescence tonics are useful. 

What is the treatment for angina pectoris? 

For the attack, hypodermics of morphia are necessary. In- 
halations of amyl nitrite or nitro- glycerin in full doses may 
prove beneficial. In the interval between the attacks the 
patient must lead a quiet life. The functions of the body 
should be well looked after, and the administration of the 
nitrite of sodium with strychnine is of use. 

What should be done to give relief in intestinal ob3tnic= 
tion? 

The treatment is largely surgical. Opium should be given 
to relieve the pain. If vomiting be persistent the stom ch 
tube may be used. Purgatives should be avoided. Hot tur- 
pentine stupes may be applied to the abdomen. Rectal feed- 
ing may be resorted to, but surgical interference soone • or 
later becomes imperative. Atropine in large doses hypoder- 
mically has been lately advised. 

What causes cerebro=spinal meningitis, and how should 
it be treated? 

The exciting cause is the diplococcus intra cellularis menin- 
gitidis, described by Weichselbaum in 1887. The treatment 



PRACTICE OF MEDICINE. 67 

is purely symptomatic. Cold applications to the head and to 
the spinal cord are useful. On the other hand, heat to the 
head and spine may be preferred by some patients. A laxa- 
tive dose of calomel early in the course of the disease and 
mercury throughout the entire affection has many advocates. 
Opium perhaps offers the best mode of treatment, and there 
is a remarkable tolerance for this drug even in the very 
young. If vomiting be a prominent symptom morphine 
should be given hypodermically. Chloral, the bromides and 
cannabis indica have been used, but in effect cannot be com- 
pared with the systematic use of opium. Alcohol is necessary 
when depression shows itself and asthenia is marked. 

Describe the treatment of pericarditis. 

In the first stage ice-bags applied over the precordium are 
of use in relieving pain and quieting the cardiac action. 
Small blisters at some distance from the precordium are of 
benefit, especially when there is an effusion. If pain be 
severe opium in some form is necessary. In very large effu- 
sion paracentesis is necessary, especially so if the effusion be 
purulent, in which condition surgical interference is impera- 
tive. Gentle purges from time to time are useful. A mild, 
non-stimulating diet is indicated. 

How should apoplexy due to cerebral hemorrhage be 
treated? 

The patient must be placed in bed with the head elevated. 
If arterial tension be high venesection should be performed 
immediately. Ice-bags are applied to the head. Croton oil 
or calomel is of great value in inducing free purgation. If 
the patient be unconscious for a considerable length of time 
the bladder must be evacuated with a catheter. 

What is the treatment of diarrhea occurring in typhoid 
fever? 

Large doses of bismuth, salol and some of the intestinal 
antiseptics are of value in this condition. Opium must be 
administered with great caution. 



68 PRACTICE OF MEDICINE. 

Give the treatment of whooping=cough. 

Food should be abundant and nutritious, and if the child 
vomits during a paroxysm nourishment should be immediately 
readministered. Antipyrine in doses proportionate to the 
age of the patient has some influence on the paroxysms. 
Bromoform is of use, but is very likely to give rise to nausea. 
Good hygiene is essential in the treatment of the case. 

What is the natural duration of whooping=cough? 

From six to eight weeks. 

What measures should be adopted in the treatment of 
pulmonary edema? 

The treatment is largely that of the primary disease which 
causes the edema. There should be active purging, especially 
if cyanosis be absent. Hypodermics of atropia in large doses 
frequently repeated have been found of use in some cases. 

How should endocarditis be treated? 

The treatment consists in absolute rest in the recumbent 
posture. Digitalis should only be given for definite and fixed 
indications, and is not required unless the pulse becomes quick 
and small or irregular, or the signs of failing compensation 
occur. Strychnia is of benefit in this condition. If anemia 
persists, iron with quinine and arsenic will be found valuable. 

Name the eruptive fevers. 

Scarlet fever, measles, German measles or rubella, small- 
pox and chicken-pox. 

What measures should be employed to rid the system of 
tape=worm? 

The most reliable anthelmintics are the male fern, the pome- 
granate root, bark and its alkaloid pelletierin, kousso, pump- 
kin seed, turpentine and chloroform. Thymol is also highly 
recommended by some authorities. Before the administration 
of any of these drugs the patient should be put upon a milk 
diet for at least twenty-four hours. It is then desirable the 
night before the vermifuge is administered to give a brisk 



PRACTICE OF MEDICINE. 69 

cathartic, preferably calomel. Early the following morning 
the anthelmintic is administered, and a few hours afterward 
another purgative. 

What are the ordinary age limits of typhoid fever, and 
what conditions are essential to its production? 

The age at which enteric fever most frequently occurs is 
from 15 to 30. The predisposing causes are temperate cli- 
mate, autumn months, unfavorable hygienic surroundings, 
such as infected drinking water, food, sewage and poor drain- 
age. The exciting cause is the bacillus of Eberth or the ba- 
cillus typhosus. 

How does the cause of typhoid fever principally gain 
entrance to the human body? Outline the prophylaxis. 

Most frequently through the digestive tract in the form of 
infected drinking water or milk. The prophylaxis consists 
in the absolute destruction of the discharges and disinfection 
of the soiled linen. The drinking water should be boiled, and 
suspected milk should also be boiled. 

Describe the treatment of cancer of the stomach. 

The most important point in the treatment relates to the 
early diagnosis, with the hope of operative interference. 
Medical methods are only palliative. They consist in allevi- 
ation of the dyspeptic conditions and the pain. To accom- 
plish these ends systematic lavage and the use of opium are 
the most satisfactory agents. Strength may be maintained 
by rectal alimentation. 

Give the period of incubation, the complications and the 
treatment of mumps. 

The period of incubation is about two weeks. It may be as 
long as three weeks. There are few complications; however, 
affection of the testicles may occur, sometimes of the ovary, 
more rarely other glands. In the treatment the patient 
should be isolated, and a mild laxative given at the onset. 
Rest in bed is important. Attention should be given to the 
alleviation of pain. 



70 PRACTICE OF MEDICINE. 

Describe herpes zoster and its treatment. 

One or more groups of small vesicles seated upon a plane 
base and attended by neuralgic, burning pain, occurring along 
the course of one or more branches of a nerve, is known as 
herpes zoster. The process is acute and self-limited. Mild 
cases rarely require any constitutional treatment. In the 
more severe cases remedies which invigorate the nervous sys- 
tem are of value. Zinc phosphid every three or four hours 
seems to be of service, and in some cases quinin and strychnin 
are useful, also arsenic. If the pain be very severe opium in 
some form is useful. Antipyrin, phenacetin and salicylate 
of sodium have been highly recommended. A dusting powder 
consisting of oxid of zinc, boric acid and talc should be ap- 
plied over the vesicles. This may be changed daily or every 
few days. 

Give the symptoms and treatment of exophthalmic 
goitre. 

The four cardinal symptoms of exophthalmic goitre are 
enlargement of the thyroid gland, protrusion of the eye-ball, 
tachycardia and tremor. Hydrotherapy is often valuable; 
rest in bed and ice-bags applied to the precordium give much 
relief to the patient. Digitalis, aconite, veratrum viride, 
tincture of strophanthus and potassium bromid have been 
employed in this disease. Thyroid extract has also been lately 
recommended. Removal of the thyroid gland has been prac- 
ticed with but little benefit. 

Name five diseases caused by a known germ. 

Tuberculosis, enteric fever, cholera, plague and diphtheria. 

Describe the treatment of neurasthenia. 

The study of the individual case is important. The rest 
cure is applicable in many cases, while in others a change of 
climate is of great benefit. Hydrotherapy, electricity, mas- 
sage and hypnotism have all been of value in the treatment. 
The diet must be easy of digestion. In the cerebral variety 
the bromids are valuable. In the gastric variety arsenic in 



PRACTICE OF MEDICINE, 71 

the form of Fowler's solution is of service. Syrup of the 
hypophosphites and valerian, caffeine, hyoscin and phenacetin 
are of benefit in suitable cases. Opium and other hypnotics 
must be used with great caution. Iron and cod-liver oil are 
useful. Systematic exercise is of great benefit. 

Give the morbid anatomy and physical signs of acute 
endocarditis. 

The lesions are usually situated in the left side of the heart. 
The endocardium lining the valves is most frequently affected. 
The lesions are small vegetations varying in size from one to 
four millimeters in diameter. Usually micro-organisms are 
associated with simple endocarditis. Microscopically the first 
change noted in the endocardium is the granular degeneration 
of the epithelial cells. In the sub-endothelial tissues blood- 
vessel changes that accompany inflammation are noted. Co- 
agulation necrosis and the proliferation of the fixed cells 
are found. The inflammatory exudate, the sub-endothelial 
tissues and the fibrin upon the free surface cause the bulging 
or warty excrescences. Upon this projection, fibrin from the 
blood stream is also deposited. Intermingled with the exu- 
date the various micro-organisms may be present. Early on 
inspection no change is usually noted, and the important 
physical signs can only be discovered upon auscultation. As 
the mitral valve is most frequently involved, a systolic mur- 
mur, which has its maximum intensity at or near the apex, 
and is transmitted to the left axilla, and often to the angle 
of the scapula, shows that mitral regurgitation has taken 
place. The murmur is at first soft and blowing in character. 
When other valves are implicated murmurs related to them 
occur. 

Mention the causes and symptoms of gastralgia. 

The condition consists in severe boring, rumbling, painful 
contractions in the epigastric region extending from the 
xiphoid cartilage and radiating to the back, accompanied by 
syncope and signs of collapse. The condition may appear 
suddenly without apparent cause, or may be due to slight 



72 PRACTICE OF MEDICINE. 

pressure in the epigastrium. It may be accompanied by the 
sensation of the globus hystericus, bulimia, frequent micturi- 
tion and vomiting. It disappears after having lasted a few 
moments. The attacks occur with marked irregularity, occa- 
sionally several taking place in one day, upon alternate days, 
or not recurring for months. It is a neurosis of the stomach. 

Describe the treatment of leukemia. 

Eest in bed is desirable, and a nutritious diet should be 
given. Arsenic should be administered early, and the dose 
increased to the point of tolerance. This drug seems to have 
a marked beneficial effect. Ergot has been recommended; 
bone marrow and iron are also found to be useful, especially 
when arsenic is not well borne. Oxygen inhalations may be 
beneficial. 

Describe the symptoms and treatment of multiple 
sclerosis. 

The first symptoms may appear after some mental or phys- 
ical strain, the patient behaving as if affected by hysteria. 
There may be temporary aphonia, from which there may be 
speedy recovery, or numbness may occur in some part of the 
body. These symptoms may disappear for a time and re- 
appear with increased severity. Charcot has given the fol- 
lowing description: The patient develops spastic paraplegia 
with exaggerated reflexes, with ankle clonus and limited 
movements. An irreg>ular jerky tension tremor occurs, nys- 
tagmus being a prominent symptom. Diplopia and paralysis 
of the ocular muscles are common. Scanning speech is prom- 
inent. There are parasthesia, tinnitus aurium and vertigo. 
The mental faculties are blunted, and in some few cases apo- 
plectiform and epileptiform convulsions occur. Trophic 
changes arise late in the disease, the sphincters, however, 
remaining normal. The treatment is the same as in other 
forms of sclerosis. The salts of gold, silver and arsenic have 
been recommended. 



PRACTICE OF MEDICINE. 73 

Describe the eruptions in the eruptive fevers. State 
where they first appear and the time of their appearance. 

In scarlet fever the eruption occurs at the end of the first 
day or beginning of the second day. It consists of pin-head 
points appearing first upon the neck and chest and spreading 
rapidly all over the body, except certain parts of the face, the 
mouth and chin. These red points, which are close together, 
soon coalesce, giving a diffuse pinkish or reddish appearance 
to the entire skin, which presents a boiled lobster color. Some 
slight edema may also be noted. Throughout the entire erup- 
tion raised papules are found. The eruption lasts about four 
or five days, and disappears by desquamation. The eruption 
in measles occurs upon the fourth day. It appears first upon 
the face and neck, and spreads rapidly over the entire body. 
The eruption consists of rose-red or brownish maculo-papular 
points raised above the skin, with intervening healthy skin, 
often arranged in a crescentic shape, especially upon the fore- 
head and wrists. The eruption remains at its height for about 
four days. The eruption in rubella appears upon the first 
day, and occurs irregularly over the face, neck, chest, body 
and limbs, varying in individual cases and in different epi- 
demics. This multiform eruption may resemble erythema, 
urticaria, and in some cases that of true measles or scarlet 
fever. It may be confluent or diffuse, lasting from two to 
four days. The eruption in small-pox occurs upon the third 
day. The temperature falls as the eruption occurs. The 
eruption may be discrete or confluent. At first the rash is 
about the size of a pin-head, and soon becomes hard, feeling 
like a shot under the skin. The macular eruption is rapidly 
converted into a papule of a reddish color. There may be 
itching and burning attending these early eruptive symptoms. 
In from twenty-four to forty-eight hours the rash has invaded 
the entire body. The earlier papules soon become vesicular, 
this change taking place about the sixth or seventh day from 
the onset of the attack. In a day or so the fluid becomes 
turbid and purulent, the top being held down (primary um- 
bilication). In from twenty-four to forty-eight hours this 



74 PRACTICE OF MEDICINE. 

umbilication has disappeared, the top now being conic in 
shape. About this time an intense red inflammatory areola 
is noticed about the base of the pock, and the eruption is now 
exceedingly painful. On or about the ninth day from the 
beginning of the disease suppuration begins in the pock, last- 
ing about three days, when the apex of the cone drops in, due 
to the absorption of the contents of the pock (secondary um- 
bilication) . When absorption has been completed a crust 
forms that may remain for some days, these crusts falling off 
on or about the sixteenth day from the beginning of the dis- 
ease, leaving depressed striated scars. The eruption in vari- 
cella occurs upon the first day, and marks the beginning of 
the disease. The exanthem shows itself as a small reddish 
point or papule, which in a very few hours becomes a vesicle. 
It is slightly elevated above the skin rather than having the 
appearance of being under the skin ; the vesicles are thin and 
transparent, and from one-eighth to one-quaiter of an inch 
in diameter. There is usually no areola. In the course of a 
few hours the vesicle becomes milky and begins to shrivel, 
with depression at the top from absorption of its contents. 
This results as a yellowish-brown crust that in about ten days 
from the beginning of the attack, and even before this, sepa- 
rates, leaving a more or less well-defined scar, which in some 
cases, especially upon the face, remains permanently. The 
pocks may appear upon the face, neck, scalp, wrist and some 
parts of the body. 

Give the symptoms of acute pericarditis. 

It is impossible to diagnosticate a true pericarditis by 
symptoms without a careful physical examination. The dis- 
ease commonly begins with severe pain in the region of the 
precordium. The pulse rate increases, and may be from 90 
to 160 per minute. In some cases it may be normal, or when 
effusion occurs the pulsus paradoxus occurs. Fever of some 
degree is usually present. The most important sign is a fric- 
tion sound, which varies greatly in intensity. It is limited 
to the precordial area, and is heard most frequently at the 



PRACTICE OF MEDICINE. 75 

base of the heart. It is increased by pressure with the stetho- 
scope. If an effusion develops the friction sound disappears, 
and returns again as absorption takes place. 

What are the general symptoms in encephalic tumors? 

The general symptoms which are characteristic consist in 
headache, optic atrophy, sensory disturbances, convulsions, 
vomiting, vertigo and bradycardia. 

What are the complications and sequelae of cerebro= 
spinal fever? 

The important complications are bronchopneumonia, bron- 
chitis, croupous pneumonia, endocarditis and pericarditis. 
The sequels are exceedingly common. They consist in affec- 
tions of the special senses. There may be loss of sight, per- 
manent deafness, loss of smell, loss of taste, various forms of 
paralysis und neuralgia. 

Describe the eruption of typhus fever. 

The characteristic eruption of typhus appears upon the 
fifth day of the disease, and in its early stages closely resem- 
bles measles. Macular spots of irregular size and outline, 
and of a dirty pinkish or reddish color, characterize the ex- 
anthem. It appears first upon the chest and abdomen, and 
extends to the extremities, the face being rarely affected. It 
is particularly copious upon the extremities, where later in 
the disease it becomes darker or petechial. Another erup- 
tion is also characteristic, and consists of marbling or mottling 
of the skin. This rash lasts throughout the disease, and does 
not disappear in death. 

Describe the treatment of measles. 

There is no specific treatment, and in uncomplicated cases 
medicines are unnecessary. A mild laxative at the onset is 
useful. The entire treatment should be directed to the pre- 
vention of complications, especially bronchopneumonia. When 
complications occur they must be treated upon general prin- 
ciples. 



76 PRACTICE OF MEDICINE. 

Give the physical signs of a cavity of the lung in pul= 
monary tuberculosis. 

If the cavity be large and superficially situated there will 
be depression upon inspection. Upon palpation, if the cavity 
be empty, there will be increased vocal fremitus. Upon per- 
cussion, if the cavity is empty, a tympanitic note may be elic- 
ited. If the cavity communicate with the bronchus a cracked- 
pot sound may occur. If the cavity be filled dulness will be 
noted upon percussion. On auscultation, if the cavity be 
empty, increased vocal resonance and cavernous breathing 
will be heard. If fluid be present in the cavity bubbling rales 
are heard. Around the cavity a friction sound is frequently 
noted. 

Give the etiology and treatment of hemothorax. 

Hemothorax may result from traumatism, caused by frac- 
ture of a rib or wounding of a lung. It may also result from 
rupture of an aneurysm, from malignant disease of the lung, 
and in the hemorrhagic diathesis. If the hemothorax be mod- 
erate in size it should not be interfered with, as subsequent 
absorption and clotting will take place. Rest and the free 
administration of opium are necessary. Avoid stimulation, 
for it will interfere with the formation of a clot. 

Describe the Brand method of treatment in typhoid 
fever. 

When the temperature in the axilla reaches 102.6° F. a cold 
bath is given, and repeated every three hours, the water being 
at a temperature of about 70° F. The patient should be 
immersed in the tub, the water covering all but the head ; then 
water of a lower temperature should be poured upon the 
patient's head or a wet ice pack used. Gentle friction should 
be applied constantly by the attendants, and the patient 
should be encouraged to do likewise. The abdomen should 
not be rubbed. The duration of the bath is 15 minutes. 
Some alcoholic stimulant should be administered to the pa- 
tient before and after the bath. When the bath is finished 
the patient should be lifted back to his bed and covered with 



PRACTICE OF MEDICINE. 77 

woolen blankets. The temperature should be taken one-half 
hour afterward to note the fall produced by the bath. 

Give the symptoms and treatment of myocarditis. 

The symptoms may be entirely latent, and the condition in 
mild grades is not likely to be recognized. In the advanced 
stages pain in the precordium, especially upon slight exertion, 
becomes prominent. It radiates and shoots down the left 
arm, and tingling may occur in the fingers. Shortness of 
breath is a prominent symptom. The apex beat is weak and 
diffused, the pulse is feeble, and often intermittent. Marked 
arrhythmia occurs. Constipation and gastric disturbances 
are common. In advanced stages edema of the skin may 
occur. The treatment consists in careful regulation of the 
diet, attention to the functions of the body, and the systemic 
use of such drugs as alcohol, strychnia, iodide of potassium 
and arsenic. 

What is the practical import of hematuria, and how can 
its source be diagnosed? 

Blood in the urine is caused by the presence of red blood 
corpuscles, the color being of a reddish hue. When blood is 
derived from the bladder the first that is passed will contain 
a smaller amount of blood than the last. Blood from the 
bladder may be copious in amount, and this urine in contrast 
to that containing blood from the kidney, upon standing, will 
show fibrin. Blood from the kidney is more likely to be inti- 
mately mixed with the urine, and if coagula be present they 
are apt to be washed out. From the urethra only the last 
drops are likely to be bloody. 

Give the etiology of scarlet fever. 

Age is an important predisposing cause. It rarely occurs 
after the tenth year of life. Neither sex nor occupation pre- 
dispose to it. The disease is more common in cold and tem- 
perate regions. Epidemics are more prevalent in the winter. 
In this disease there is a marked personal predisposition. 
One attack confers immunity as a rule. The exciting cause 
is not known. 



78 PRACTICE OF MEDICINE. 

Give the trc itment off tic douloureux. 

It is especially important to treal the underlying condition. 
If the disease 1 e lei.ex it is important to give attention to the 
affection giving rise to it. Hygienic treatment .s of import- 
ance. Change oi scene and residence, with good, nourishing 
diet, are necc-saiy. Many drugs have been recommended for 
the treatment ol the paroxysm, such as quinine, the coal-tar 
analgesics, tie salicylates, caffeine, aconite, geisemium and 
belladonna. Morphine should be avoided if possible, as there 
is great danger of tie patient acquiring the opium habit. 
Local treatment is sometimes of use thus hot and col 1 appli- 
cations, liniments containing menthol, and occasionally elec- 
tricity may he tried. In protracted cases surgical inierfer- 
ence should be thought of. 

Give the symptoms of appendicitis. 

The onset is sudden; tl e.e is pain in the abdomen, which at 
first may be general or centered around the umbilicus, and 
occasionally in tie epigastrium and in the left o right iliac 
fossa. In many cases the pain is confined to the light iliac 
fossa, and dii ect ly in the region of the appendix (> ; cBurney's 
point). If the pain is general it soon localizes itself to the 
right iliac fossa, usually within the course of twenty-four 
hours. It is paroxysmal or intermittent, and colic like. This 
pain may be preceded by chilliness. Fiequently nausea and 
vomiting mark the beginning of the attack. Fever rapidly 
follows the onset of the disease, which is usually moderate, 
from 100°-103° F. Occasionally it may be absent. The fre- 
quency of the pulse generally corresponds to the degree of 
the fever. Constipation is commonly present. The tongue 
is coated posteriorly. The facial expression of the patient 
shows anxiety and suffering. The position of the patient is 
often characteristic. The right thigh is most frequently par- 
tially flexed upon the abdomen, while the left leg is extended. 
Examination of the abdomen shows slight distension. On 
palpating the abdomen the right rectus muscle will be found 
rigid. Tenderness is as constant as pain. Pressure upon 



PRACTICE OF MEDICINE. 79 

the opposite side produces pain in the region of the appendix. 
In some instances the appendix may be clearly made out, and 
occasionally a tumor is palpable. 

Define aphasia and give its etiology. 

Aphasia embraces a variety of defects in the use or the 
comprehension of language, either spoken or written. In the 
majority of cases aphasia is one of the symptoms of organic 
focal cerebral disease, occurring in the left hemisphere in the 
right-handed, and vice versa. It occurs in cerebral hemor- 
rhage, thrombosis, embolism, abscess, tumor, and depressed 
fracture of the skull. Rarely it has been noted in hysteria 
and neurasthenia. 

Give the diagnosis and treatment of acute follicular 
tonsillitis. 

The diagnosis depends upon great pain in swallowing. This 
may be preceded by lassitude, malaise, headache, pain in the 
bones, vomiting, and marked fever. Examination of the 
throat shows redness and swelling of one or both tonsils, with 
yellowish-white patches upon them, varying in size from a 
pin-head to a split pea. These may be stripped off without 
leaving a bleeding surface, leaving an intact mucous mem- 
brane beneath. The breath is usually fetid. The patient 
should be put to bed and a laxative administered. The coal- 
tar products, especially phenacetin, in small doses, guardedly 
given, promptly relieve the pain. Ice bandages and small 
particles of ice in the mouth are useful. If pain and sleep- 
lessness persists, opium, especially Dover's powder, may be 
administered. 

Give the treatment of intestinal hemorrhage in typhoid 
fever. 

Pood and drink should be withdrawn; one or more ice-bags 
applied to the right iliac fossa, and opium given for effect. 
The head of the bed may be lowered and the foot of the bed 
elevated. The opium should be pushed so as to produce 
mild somnolence. If thirst becomes excessive? small pellets 
of ice may be placed in the mouth from time to time. 



80 PRACTICE OF MEDICINE. 

Give the treatment of delirium tremens. 

One of the most important features in the treatment is care- 
ful feeding. Little food should be given at a time, but it 
should be frequently administered. If vomiting is persistent 
rectal alimentation may be resorted to. If there are signs of 
heart failure stimulants must be administered. Strychnin 
hypodermically is of great value. Every effort should be 
made to induce sleep. The most useful agents are morphin, 
hypodermically, or hyoscin. Chloral is also useful, but it has 
a depressing effect upon the heart. 

Give the treatment and prognosis of progressive perni= 
cious anemia. 

Rest in bed is essential, and easily digested, nutritious foods 
should be given. Arsenic has been found of most value, given 
in the form of Fowler's solution in ascending doses. If this 
drug is not well borne iron may be substituted. Bone marrow 
is also useful. Stimulants, such as strychnin and alcohol, 
and inhalations of oxygen, are of advantage. The prognosis 
is always grave. Death results in from a few months to a few 
years. Apparent recovery followed by relapse is common. 

Give the symptoms of acute exudative nephritis. 

The disease may begin suddenly or gradually. Edema 
develops rapidly. The urine becomes scanty and high col- 
ored, and uremic symptoms, such as vomiting and convulsions, 
occur. The edema at first is most marked in the face, partic- 
ularly about the eyelids. There is dull headache, with pain 
in the back and loins, dryness of the skin and dyspnea. The 
temperature is sub-febrile. The urine upon examination 
shows that it is decreased in amount, the color is dark red and 
is turbid, blood being present. The specific gravity is from 
1020 to 1030, and upon testing the urine large quantities of 
serum albumin are found. The quantity of urea is usually 
less than normal. Under the microscope hyaline, granular 
and epithelial casts are noted, with renal epithelium red blood 
cells and granular matter. 



PRACTICE OF MEDICINE, 81 

Define and describe bronchorrhea. 

This is a rare form of bronchitis, characterized by an exces- 
sive amount of secretion, which is very foul. It is sometimes 
called purulent bronchorrhea. The quantity of expectoration 
varies from one to three pints. The character may be either 
thin or watery or it may be transparent or ropy. Dyspnea 
and cough are always present, often being persistent and 
paroxysmal. 

Define hydronephrosis. State its causes and describe 
its treatment. 

Obstruction to some part of the ureter, bladder or urethra 
may give rise to dilatation of the pelvis and tubules of the 
kidney from accumulation of urine. It may be due to the 
twisting of the ureter, it may result from congenital narrow- 
ing of the ureter or urethra, from pressure. The treatment 
is largely surgical. Massage may be practiced with favorable 
results. However, if the condition persists aspiration and 
drainage are necessary. 

Give the symptoms and treatment of migraine. 

The principal symptom is the headache, which shows greater 
or lesser periodicity. This symptom is followed by pallor and 
some vasomotor spasm. As a rule the disease is unilateral, 
the left side being oftener affected than the right. The pupil 
upon the affected side is often smaller, and the eye may be 
retracted. Often there is disturbance of vision, the duration, 
however, being temporary. Occasionally, tinnitus aurium 
occurs, which may be associated with vertigo. These symp- 
toms are accompanied in the majority of cases by marked 
gastric disturbances, such as nausea, with frequent vomiting. 
The treatment consists in relieving the pain and the preven- 
tion of its recurrence. The following drugs have been recom- 
mended: Ergot, the coal-tar products, salicylate of sodium, 
the bromids, caffein and gelsemium. As a prophylactic, nitro- 
glycerin taken after meals with bismuth and pepsin has been 
said to be of value. Mild purging with calomel from time to 
time often prevents attacks. 
6 



82 PRACTICE OF MEDICINE. 

Mention a disease of the nervous system in which the 
patella reflex usually disappears; one in which it is usually 
exaggerated. 

In locomotor ataxia the knee-jerk usually disappears; in 
spastic paraplegia, as a rule, the knee-jerk is exaggerated. 
Define myxedema and give its treatment. 

This is a disease characterized by a myxomatous change in 
the subcutaneous tissues due to pathologic lesions in the thy- 
roid gland causing diminished or absent secretion. Thyroid 
extract should be administered as early as possible, and should 
be continued until all the symptoms disappear, and then a 
prophylactic dose must be given regularly. General tonics, 
such as iron, quinin and strychnia, are of value. 

Define simple acute stomatitis; at what age is it most 
common and what is its treatment? 

This is an inflammation of the mucous membrane of the 
mouth. The disease is most frequent in children, but may 
also occur in adults. The treatment consists in cleanliness, 
careful feeding, and the use of a mild alkaline mouth wash. 
A mild purge is often advantageous. 

Give the causes and treatment of bronchial asthma. 

The disease is sometimes hereditary. It is more common 
in males than in females. It may follow an attack of bron- 
chitis, and is commonly associated with chronic bronchitis 
and emphysema. The inhalation of dust, the pollen of 
certain plants, fog, fumes, vapors, odors that emanate from 
certain animals may produce an attack of asthma. Reflex 
causes, as irritation from nasal polypi, causes relating to the 
gastro-intestinal tract, skin or genito-urinary center may act 
in a like manner. For the treatment of the paroxysm nar- 
cotics and anti-spasmodics are usually employed. Chloral, 
whiffs of chloroform or ether, amyl nitrite by inhalation, or 
morphia and atropia hypodermically are useful drugs. Re- 
lief sometimes follows the inhalation of nitre paper cigarettes, 
which also contain lobelia and stramonium, Sinapisms and 
turpentine stupes to the chest may be of value. 






PRACTICE OF MEDICINE. 83 

Give the treatment of an acute attack of gout. 

A mild laxative at the onset is useful. The affected joint 
should be kept at rest, and a diet of milk and farinaceous 
articles, with plenty of water, should be insisted upon. If 
the pain become severe opium in some form must be adminis- 
tered. For the attack itself colchicum is the remedy. Iodid 
and bromid of potassium are also useful, as are also the sali- 
cylates and the salts of lithia. 

State the prognosis in aneurysm of the thoracic aorta. 

The prognosis is always grave, death invariably resulting. 



THERAPEUTICS AND MATERIA 
MEDICA. 



For what purposes are diuretics employed? 

Diuretics are administered with the object of increasing the 
quantity of urine excreted: to promote the elimination of 
waste products and other poisons from the blood: to dilute 
the urine and to alter morbid conditions of the urine. 

Give the source, the common name and the principal 
therapeutic uses of oleum theobromae. 

Oil of theobroma is commonly called Cacao-butter. It is a 
fixed oil expressed from the seeds of theobroma cacao, the 
chocolate tree, which is found in Mexico, the West Indies and 
South America. Oil of theobroma consists chiefly of stearin 
with a little olein. It has a demulcent action. Its chief use 
is as a base for making suppositories. 

What are the varieties of sinapis used in medicine, how 
are they used and for what purpose? 

There are two varieties of sinapis (mustard), sinapis alba 
and sinapis nigra. It is directed, however, that pharmaco- 
pceial preparations be made from black mustard only. Lo- 
cally used, mustard is rubefacient, counter-irritant and a nerve 
stimulant, causing heat, redness and severe burning pain. 
Its prolonged application produces vesication by inducing 
local inflammation. Internally it is a local emetic in full 
doses; in smaller doses it has a carminative action. On the 
gastric mucous membrane its irritant effect is much less pow- 
erful than on the skin. Mustard is commonly used as an 
application to relieve local pain and to produce counter irri- 
tation. Internally it may be employed as an emetic in indi- 

(85) 



86 THERAPEUTICS AND MATERIA MEDICA. 

gestion or narcotic poisoning. Its use as a condiment is 
general. The oil of mustard is one of the most irritant of the 
volatile oils, producing severe gastro-enteritis. 

What are the causes and treatment of urticaria? 

Urticaria is an inflammatory affection, characterized by the 
eruption of pale-red, evanescent wheals, which are associated 
with severe itching. It is due to gastro-intestinal disturb- 
ances and emotional excitement. Chronic visceral diseases 
predispose. It is produced in susceptible individuals by cer- 
tain articles of food, as well as the bites of insects, and by 
certain drugs. Treatment: Remove the cause when possible. 
Especial attention should be paid to removing gastric irrita- 
tion and securing a free movement of the bowels with a saline 
laxative. The special remedies recommended are the alkalies, 
salicylate of sodium, quinine, iodide of potassium, atropine 
and antipyrin. Locally, lotions of water and alcohol, carbolic 
acid, boric acid or hydrocyanic acid are very useful. 

Name three drugs belonging to each of the following 
classes: narcotics, diaphoretics, ecbolics. 

Narcotics: opium, hyoscyamus and alcohol. Diaphoretics: 
pilocarpine, aconite and cocaine. Ecbolics : ergot, oil of rue 
and savine. 

What are the physiological effects and the therapeutic 
uses of Phytolacca? 

Phytolacca is an emeto-cathartic possessing slow but per- 
sistent action, with great nausea and considerable depression. 
It lowers the rate of respiration and of cardiac action, and is 
a motor depressant, paralyzing the spinal cord and the me- 
dulla. Death occurs from paralysis of respiration preceded 
by tetanic convulsions. The drug is said to possess alterative 
properties, and has been used internally and externally in 
chronic rheumatism and chronic skin affections. It produces 
the absorption of adipose tissue, and has been used as a 
remedy in obesity. Considering its physiologic action its 
employment is not justifiable. 



THERAPEUTICS AND MATERIA MEDIC A./ 87 

From what source besides nux vomica is strychnine 
obtained? What other alkaloid is obtained from the same 
sources? 

Strychnine is derived from Ignatia, St. Ignatius' Bean, 
which contains the alkaloids, strychnine and brucine, about 
1 per cent, of each. 

How do borax and boric acid differ chemically and the= 
rapeutically? 

Boric acid, H 3 B0 3 , is a weak acid occurring in transparent, 
colorless six-sided plates. It is odorless, of a slightly bitter 
taste, and is soluble in 25 parts of water, in 15 of alcohol and 
in 10 of glycerine. Borax is the borate of sodium, Na 2 B 4 7 
+ 10H 2 O; it occurs in colorless, transparent prisms of cooling 
and sweetish taste and alkaline reaction. It is soluble in 16 
parts of water at 59° F., and is insoluble in alcohol. Boric 
acid may be produced from borax by the action of sulphuric 
acid. The action of borax differs from that of boric acid in 
being a more powerful antiseptic and disinfectant, as well as 
being far more irritating when locally applied. 

Name the official preparations of gold and describe its 
therapeutic uses. 

Gold, aurum, has but one official salt, the gold and sodium 
chloride, but triturations of the metal itself may be prepared 
according to the general pharmacopoeia! formulas for such 
preparations. Gold has been recommended in certain forms 
of gastric disturbance, in chronic Bright 's disease, in certain 
nervous disorders, in impotence and in pertussis. It is not 
generally employed. 

What is the adult dose of (a) sulphate of atropin, (b) 
tincture of cantharides, (c) tincture of~colchicum? 

(a) 1-200 to 1-50 gr. (b) 1 to 5 minims, (c) 20 to 90 
minims. 

Mention three alkaloids which are chemically alike and 
almost identical in* physiologic effect. 

Cinchoninaa Sulphas, Cinchonidinas Sulphas and Quinidinae 
Sulphas. 



88 THERAPEUTICS AND MATERIA MEDIC A. 

State the cause and give the treatment of trichinosis. 

Trichinosis is a typhoid condition resulting from the en- 
trance of a parasite, the trichina spiralis, into the intestinal 
canal and the subsequent migration of these parasites into the 
muscular structure. The trichina are introduced into the 
human body by ~ating infected hog's flesh, either raw or im- 
perfectly cooked. The preventive treatment consists in eating 
no pork that has not been perfectly cooked. It the parasites 
have been recently taken, emetics and purgatives are indi- 
cated. After migration has begun the powers of life should 
be sustained by nourishing food, stimulants and tonics. 

What drug is antagonistic to pilocarpine? 

Atropine in dose of 1-100 gr. for each 1-6 gr. of pilocarpine. 
Where is the habitat of belladonna? 

It is indigenous in the mountainous districts of central and 
southern Europe and Asia, and is cultivated in Europe and 
in the United States. 

What are the sources of sulphur? 

Sulphur is obtained native in several volcanic districts or 
from the native sulphides of iron and copper by roasting as 
it sublimes at about 238° F. 

Mention four preparations of digitalis, with the dose of 
each for an adult. 

Digitalis in the form of powdered leaves may be given in 
dose of one-half to three grains : the fluid extract of digitalis 
in dose of one-half to three minims : the tincture of digitalis 
in dose of five to twenty minims : the infusion of digitalis in 
dose of one to four drams. 

In what dose may the oil of wintergreen be administered 
to an adult for rheumatism? 

Ten to twenty minims. 

How is nitrite of amyl administered and for what pur= 
pose? 

Nitrite of amyl is indicated for the same general conditions 



THERAPEUTICS AND MATERIA MEDIC A. 89 

as nitro- glycerin. It is generally prescribed in glass pearls 
containing 3-5 minims, and these are broken in a handkerchief 
and inhaled. It is a valuable heart stimulant, checks spasms 
and dilates peripheral vessels. It is especially employed for 
the relief of attacks of angina pectoris. 

Describe the therapeutic uses of sparteine and state the 
dose of the sulphate for hypodermic uses. 

Sparteine is the alkaloid of Scoparius, Broom, and is a 
valuable diuretic and heart stimulant. Its dose hypodermic- 
ally is from 1-16 to % grain of the sulphate. 

What are the physiologic effects and the therapeutic 
uses of the balsam of Peru? 

Balsam of Peru is employed locally as a sedative and para- 
siticide. Internally it is of value as an expectorant in chronic 
bronchitis. This balsam is antiseptic, disinfectant, stimulant 
to the circulation and sedative to the nervous system, acting 
chiefly on the mucous membrane ; it is a tonic and expectorant, 
diuretic and diaphoretic. 

Give the common name, therapeutic uses and dose of 
sodium sulphate. 

Glauber's salt; it is a powerful purgative, and is prescribed 
in doses of 1 to 4 drams. 

Describe the therapeutic uses of sodium chloride. 

A bath may be made more stimulating for debilitated pa- 
tients by the addition of a few ounces of salt to the water. 
An enema containing one or two tablespoonfuls of salt to the 
pint of water is sometimes used effectively against thread- 
worms. The subcutaneous or intravenous injection of a 3-10 
per cent, solution of sodium chloride has proven of marked 
benefit in cholera, uremia and acute anemia from hemorrhages. 

State the composition and therapeutic uses of pulvis 
jalapae compositus. 

Compound powder of jalap contains of jalap 35 parts, of 
potassium bitartrate 65 parts, rubbed together until thor- 



90 THERAPEUTICS AND MATERIA MEDIC A. 

oughly mixed. It is much employed to produce free watery 
evacuations in ascites and anasarca. Since it is nearly taste- 
less, it is a useful cathartic for children. 

What is a physiologic action of camphor in medicinal 
doses on (a) the skin, (b) the circulation? 

(a) Rubefacient; (b) increases the pulse rate and raises 
arterial tension. 

Describe the forms of poisoning by ergot. 

There are two forms, the acute ergotism and chronic ergot- 
ism. The symptoms of the acute form are nausea, vomiting, 
colic, difficult micturition and purging. The drug slows the 
heart, raises arterial tension, dilates the pupil and produces 
vertigo. It stimulates the contraction of unstriped muscle 
fiber, especially affecting the sphincters and uterus. In very 
large dose it produces cerebral and spinal anemia and violent 
convulsions. There are two varieties of the chronic ergot 
poisoning, the convulsive and the gangrenous. The convul- 
sions are tetanoid spasms of the flexor muscles, the uterus, the 
intestinal fibers and muscles of respiration, ending in coma 
and death by asphyxia. The gangrenous form begins with 
coldness and numbness of the limbs, formication of the skin, 
loss of sensibility and abolishment of the special senses, bullae 
of blood and ichor, followed by dry or moist gangrene of the 
lower extremities, buttocks and other parts, epileptiform con- 
vulsions, coma and death. 

In what pathologic condition is veratrum viride useful? 

Locally, veratrine is of value in neuralgia. Internally the 
drug is advised by some in the early stages of sthenic pneu- 
monia and in puerperal eclampsia. 

Mention the therapeutic uses of phenacetin. 

It is antipyretic and analgesic and hypnotic. It is useful 
in whooping-cough and rheumatic and other fevers. 

Give the name of the alkaloid of Calabar and state its 
dose. 

Physostigmine (or eserine). The dose of the sulphate is 
1-100 to 1-50 gr. 



THERAPEUTICS AND MATERIA MEDICA. 91 

Mention the salts of lithium and describe their medicinal 
uses. 

Benzoate, bromide, carbonate, citrate, salicylate and urate. 
The carbonate and citrate are used extensively in gout and 
the lithemic diathesis. The lithium salts have strong alka- 
line qualities, and act on the system as other alkalies. Lith- 
ium bromide is prescribed for the effects of bromide. 

What are the therapeutic uses of lobelia? 

It is used as an expectorant, diaphoretic, emetic, purgative 
and anti-spasmodic properties. 

Mention the official preparations of copper. Give the 
dose of each. 

There is but one official preparation, the sulphate, which is 
given as an emetic in doses of 2 to 5 grains every 10 or 15 
minutes, and as a tonic in dose of 1-6 to % grain. 

What are the therapeutic uses of Croton oil? 

Externally it is applied as a counter-irritant in bronchitis, 
neuritis, rheumatism and ovaritis. Internally it is used as a 
prompt hydragogue cathartic and revulsant in acute cerebral 
congestion, apoplexy and uremia. In these cases it not only 
causes general depletion, but also a rapid efflux of blood from 
the brain. 

.What are the uses of the bromides? 

The bromides are used as sedatives to the nervous system, 
to lower reflex activity, to produce sleep, to subdue excitement 
of the genital apparatus and to antagonize congestion of the 
brain. 

Give the indications for the use of corrosive sublimate 
internally. 

As an antisyphilitic, as a hematinic, in gastric ulcer and 
early stages of hepatic cirrhosis and in dysentery. 

What remedies are employed to correct anemic condi- 
tions and how are they used? 

Nux vomica, stimulates the blood-making organs, and is 



92 THERAPEUTICS AND MATERIA MEDIC A. 

used as an adjunct to restorative remedies. Iron, the chief 
value of which is to improve digestion and to furnish hematin 
to the blood. The astringent preparations are the best, and 
should be given after meals. Arsenic as an adjunct to iron. 
Arsenic increases the number of blood cells, while the iron in- 
creases the hemoglobin contained in each. Bichloride of mer- 
cury, quinine and manganese increase the number of red blood 
cells. In the treatment of anemia it is of importance to 
determine the cause when possible. This will frequently be 
found to be due to gastro-intestinal irritation or constipation. 
General tonic treatment, with the proper diet and hygienic 
surroundings, are often more valuable than drug treatment. 

Describe the therapeutic uses of the preparations of 
phosphorus. 

Phosphorus is chiefly used to promote the nutrition of 
osseous and nervous tissue. Very small doses of the drug 
have been found of excellent service in functional impotence 
in certain skin diseases, in pernicious anemia and in neuralgia. 
Calcium phosphate and the hypophosphites are used with 
benefit in all diseases of malnutrition and where the repair 
or development of the bones is required. They are particu- 
larly useful in protracted suppuration, osteomalacia, rachitis, 
caries, chronic phthisis and in the anemia and bone-softening 
of lactation. Sodium phosphate is a well known purgative. 

Indicate the manner in which ethylic ether (sulphuric 
ether?) should be applied to produce general anesthesia. 

As an anesthetic it may be administered from a sponge, a 
folded towel surrounded by a cone of pasteboard, or from an 
inhaler made especially for the purpose. At first the inhaler 
should be held some distance from the nose, to accustom the 
patient to the irritant effects of the ether, but soon it should 
be brought close to the nose, so that the anesthetic may be 
taken in concentrated form. Insensibility of the conjunctiva 
and muscular relaxation are the indications that the patient 
is properly prepared for the operation. Many surgeons now 
employ preliminary anesthesia with nitrous oxide gas. This 



THERAPEUTICS AND MATERIA MEDICA. 93 

greatly shortens the first stage and allows the patient to be 
anesthetized with a comparatively small amonnt of ether. 

In what manner is the system affected by an overdose 
of chloral hydrate? 

The ingestion of a toxic dose produces sleep, which soon 
deepens into coma; the pulse becomes feeble and thready, the 
respiration embarrassed, the surface cold and clammy, the 
pupils at first contracted and then dilated, and finally death 
results from cardiac and respiratory paralysis. 

Name three general anodynes and give the dose of some 
official preparation of each. 

Opium, belladonna, cannabis indica. Morphine sulphate, 
% gr. Sulphate of atropine, 1-100 gr. Extract cannabis 
indicae, % to % gr. 

State the precautions which should ordinarily be ob- 
served in administering medicines by the hypodermic 
method. 

The medicine must be in solution, and the latter should be 
neutral in reaction and freshly prepared. The skin of the 
patient should be rendered aseptic at the place selected for 
the injection. The solution is to be injected beneath the skin 
and not into it, and the blood vessels and nerve points are to 
be especially avoided. 

Give the physiological effects of cinchona. 

Cinchona is an astringent bitter and a stomach tonic. At 
first it promotes appetite, digestion, the flow of saliva and 
gastric juice; long continued it sets up a gastric catarrh, 
impeding digestion and causing constipation. Its action is 
more astringent and irritating than that of its alkaloid, qui- 
nine. Its active principles are more slowly absorbed by rea- 
son of its bulk. In large dose quinine causes headache, ring- 
ing in the ears and some deafness. It is antipyretic and a 
heart depressant. On the nervous system it causes congestion 
of the brain and acts as a cerebral excitant; moderate doses 
lessen reflex activity by stimulating Setschenow's inhibitory 



94 THERAPEUTICS AND MATERIA MEDIC A. 

center. Toxic doses permanently abolish the reflexes by de- 
pressing the spinal cord and peripheral nerves. Small doses 
exert no influence on the respiratory system, but large doses 
paralyze the respiratory center. 

Mention the conditions that contra=indicate the admin* 
istration of aconite. 

It is contra-indicated when there is adynamic action of the 
heart, cardiac degeneration or dilatation, and gastro-intestinal 
irritation or inflammation. 

Mention the alkaloids of nux vomica. 

It contains two alkaloids, strychnine and brucine. The 
latter resembles the former in its action, but is less powerful. 
The tincture of nux vomica is given in doses of 10 to 30 drops. 

For what pathologic conditions is salicylic acid admin= 
istered? What symptoms indicate the discontinuance of 
the use of salicylic acid? 

Externally it is used as an antiseptic in the dressing of 
wounds. Dissolved in collodion it is a valuable application 
for the removal of corns. The ointment is of service in 
chronic eczema. Internally, salicylic acid is of the greatest 
value in acute rheumatism. In neuralgia and neuritis of 
rheumatic origin it is of service, as it is in tonsillitis, pleurisy 
with serous effusion and in diabetes of gouty origin. It 
should be discontinued if the patient suffers from headache, 
ringing in the ears, deafness, paralysis of the ocular muscles, 
great fall of temperature, excessive sweating, difficult respi- 
ration, weak pulse, convulsions and olive- green urine. These 
are the symptoms resulting from a poisonous dose. 

For what conditions should (a) tincture of digitalis be 
given, (b) infusion of digitalis be given? Mention the 
dose of each. 

When the cardiac action of digitalis is desired the tincture 
should be employed, and no fluid should be taken within 
twenty minutes either before or after swallowing. If the 
diuretic action is required the proper preparation is the infu- 



THERAPEUTICS AND MATERIA MEDIC A. 95 

sion. The dose of the tincture is from 5 to 20 minims. The 
dose of the infusion is from 1 to 4 drams. 

Write a prescription illustrating chemical incompati= 
bility. 

Salicylic acid is incompatible with the salts of iron; a pre- 
scription containing tincture of iron and salicylic acid would 
furnish an example of such incompatibility. 

Mention the principal physiologic effects of jaborandi. 
Give the alkaloids of jaborandi. 

Jaborandi is a powerful diaphoretic and sialogogue, a car- 
diac depressant, by stimulation of the vagus ends; it is also 
myotic, emetic and under some circumstances abortifacient. 
Jaborandi contains four alkaloids, pilocarpine, jaborine, pilo- 
carpidine and jaboridine. 

What are the earliest signs of poisoning from the ex- 
ternal use of carbolic acid? 

Early symptoms are smoky color of the urine, lumbar pain, 
slight cerebral disturbance, after which develops impairment 
of respiration and stupor. Applied in concentrated form it 
is irritant and superficially escharotic, and produces at the 
point of application a white spot, changing to red if the acid 
is soon removed. If the application is prolonged a white 
slough results from coagulation of the albumen of the tissue ; 
this is bordered by a red zone of inflammation. 

Mention the ingredients and the dose of pulvis glycyr= 
rhizae compositus. 

Compound liquorice powder contains senna 18, glycyrrhiza 
23%, oil of fennel 4, washed sulphur 8, sugar 50 ; the dose is 
one dram. 

For what conditions should blisters be applied? De= 
scribe the application of blisters. 

Blisters are applied for the purpose of producing counter- 
irritation. The proper manner of employing a counter-irri- 
tant to affect inflammation is not to apply it directly to an 



96 THERAPEUTICS AND MATERIA MEDICA. 

actually inflamed area, but a little to one side of it, at a spot 
known to be connected intimately with the diseased area by 
nerve fibers. 

By what other name is liquor potassae known? State 
the dose of liquor potassae. 

Liquor potassce is also called solution of potassa. Its dose 
is 5 to 30 minims well diluted with water. 

Mention the antagonist of cocaine. 

Ammonia and amyl nitrite combat the earliest symptoms 
of cardiac depression produced by cocaine. The most direct 
antagonist is chloral; then follow chloroform, ether and mor- 
phine. 

Mention three emetics. State the dose 'of a preparation 
of each. 

Mustard, apomorphine, ipecac. The commercial flower of 
mustard is given as an emetic in dose from 2 to 4 drams. 
Apomorphine hydrochlorate 1-20 to 1-10 gr. hypodermically. 
Powdered ipecac root as an emetic 15 to 30 grains. 

In what conditions is gallic acid useful? 

Gallic acid and its congener, tannic acid, are astringents, 
the former being the feebler of the two. They constringe the 
muscular tissue in the walls of the minute vessels, thus check- 
ing secretion and hemorrhage and cutting short local inflam- 
mation. Gallic acid is useful in hematuria, passive hemor- 
rhages, chronic cystitis, chronic diarrhea, bronchorrhea and 
night sweats. 

Describe the treatment of night sweats. 

The following drugs are found useful in the treatment of 
night sweats: Sulphate of atropine, in doses of l-75th gr. at 
bed time; gallic acid, in 15 gr. doses; camphoric acid, in 10 
gr. doses; and agaricin, in dose of 1-12 to % g r - Sponge 
baths with weak solutions of alum and other astringents are 
sometimes employed. 



THERAPEUTICS AND MATERIA MEDIC A. 97 

Describe gelsemium. State the dose of the preparations 
of gelsemium. 

Yellow jasmine is the rhizome and roots of gelsemium sem- 
pervirens, a climbing plant of the natural order Loganiceag, 
with showy yellow flowers. It grows in the forests of the 
southern United States. It contains a volatile oil, a resin and 
an alkaloid, gelsemine, in combination with gelsemic acid. 
Preparations are the fluid extract, dose 2 to 20 minims; the 
tincture, dose 10 minims to 1 dram. 

Mention the therapeutic uses of iodine. 

Iodine is a useful counter-irritant. Internally it is used 
chiefly for its alterative effect. In the form of Lugol's solu- 
tion (2 or 3 drops) it will sometimes control obstinate vom- 
iting. 

State the physiologic effects of physostigma on the res- 
piration, the heart and the pupil of the eye. 

Small doses do not affect the circulation or respiration, but 
toxic doses kill by paralyzing the respiratory center. The 
arterial pressure is raised by the drug stimulating the heart 
or its contained ganglia, and probably also by stimulating the 
vasomotor center. Toxic doses paralyze the heart. Physo- 
stigmine powerfully contracts the pupil. This results from 
stimulation of the peripheral fibers of the oculo-motor nerve 
and from paralysis of the peripheral filaments of the sympa- 
thetic nerve. 

Describe the physiologic action of phosphorus. 

In small doses phosphorus stimulates the brain and circula- 
tion, the functions of the stomach and the genital organs and 
the growth of bones. It aids digestion by irritating the end 
organs of the gastric nerve, but produces eructations of hydro- 
genic phosphide. 

Outline the therapeutic uses of atropine. 

Atropine is used in poisoning by opium, physostigma and 
hydrocyanic acid. In ptyalism from mercury, pregnancy, 

7 



98 THERAPEUTICS AND MATERIA ME DIG A. 

etc., in the sweats of phthisis, in sudden cardiac failure and 
as a mydriatic. It is very useful in lead poisoning, combined 
with potassium iodide. It is useful as hemostatic in profuse 
metorrhagia after abortion, in metorrhagia of obscure origin 
and in the hemoptysis of phthisis. 

Define sialagogue. Give an example of (a) topical siala= 
gogue, (b) general sialagogue. 

Sialagogues are agents which increase the secretion and 
flow of saliva and buccal mucus. Topical sialagogues act by 
reflex stimulation, as tobacco and mustard. General siala- 
gogues act through their influence on the glands or their 
secretory nerves, as pilocarpine and the mercurials. 

For what pathologic conditions is camphor used? 

Camphor may be employed in diarrhea, cholera, vomiting, 
cardiac depression, nervousness and nervous headache, the 
infectious fevers, dysmenorrhea, after-pains, and catarrhal 
conditions. Locally it is of use wherever counter-irritation 
or a local anodyne is required. 

Give the official name and the composition of (a) Fow- 
ler's solution, (b) Donovan's solution. 

Solution of potassium arsenite is a 1 per cent, solution 
prepared by boiling together arsenous acid 1, potassium 
bicarbonate 2, compound tincture of lavender 3, and distilled 
water to 100 parts. The solution of arsenic and mercuric 
iodide (Donovan's solution) contains arsenic iodide and mer- 
curic iodide, of each 1 part in 100 of distilled water. 

Give the therapeutic uses of ammonium carbonate. 

Ammonium carbonate is a powerful and very diffusible 
stimulant. It stimulates the respiratory center and acts as a 
stimulating expectorant. It is employed in the eruptive 
fevers, pneumonia, chronic bronchitis and in cardiac asthma. 

State the dose of (a) nitro=glycerine, (b) wine of col- 
chicum (sem.), (c) extract of colocynth. 

(a) 1-100 grain, (b) 20 to 90 minims, (c) 1 to 5 grains. 






THERAPEUTICS AND MATERIA MEDIC A. 99 

Describe the therapeutic applications of sulphate of 
copper. 

It is a prompt and efficient emetic, and is so used in croup 
and narcotic poisoning. In phosphorus poisoning it forms a 
comparatively insoluble phosphide of copper, besides produc- 
ing emesis. It is of value in acute diarrhea and chronic 
dysentery combined with opium. Locally it is employed in 
throat affections, gonorrhea, granular lids, corneal ulcers and 
chronic inflammation of mucous membranes. 

Mention (a) a hydrogogue, (b) a cholagogue. State 
the dose of each. 

(a) elaterium; the active principle, elaterin, is given in 
doses of 1-20 to 1-12 gr., (b) podophyllum; dose 5 to 10 gr. of 
the extract. 

Mention four remedies used to control vomiting and 
state the dose of each. 

Cerium oxalate 2 to 5 gr., subnitrate of bismuth 5 to 20 gr., 
cocaine hydrochlorate 1-20 to % £ r -> ac id carbolic in one-drop 
doses. 

Write a compound prescription for an adult suffering 
from insomnia. 

Jan. 1, 1903. Mr. John Smith. 

B . Potassii bromidi • • • 3 iv 

Chloralis hydratis 3 iii 

Tincturae asafoetidse f 3 iv 

Syrupi * f 3vi 

Aquae, q. s. ad f ^ vi 

M. Sig. — Tablespoonful every two hours until sleep is induced. 

Jos. Jones, M. D. 

What are the uses of apomorphine? State the dose of 
apomorphine. 

In narcotic poisoning, such as from opium or alcohol, apo- 
morphine is a valuable emetic. When the circulation is weak 
it must be given cautiously. It is of service as an expectorant 
in the dry stage of acute bronchitis and in chronic bronchitis 
when the expectoration is viscid and scanty. The emetic dose 



L.ofC. 



100 THERAPEUTICS AND MATERIA MEDIC A. 

of apomorphine hydrochlorate is from 1-12 to % gr. in alcohol. 
As an expectorant by the mouth the dose is 1-40 to 1-16 gr. 

State the effect of amyl nitrite on the vascular system. 

The inhalation of nitrite of amyl is speedily followed by 
flushing of the face, fulness in the head, quickening of the 
pulse and a fall of the blood pressure. The flushing is due to 
dilatation of the arterioles, brought about partly by depres- 
sion of the vasomotor centers and partly by direct action on 
the blood vessel walls. The quickening of the pulse results 
from a depression of the cardiac inhibitory centers in the 
medulla. The fall of blood pressure is mainly due to dilata- 
tion of the vessels. Upon the heart the drug acts primarily 
as a stimulant, but in large amounts it soon acts as a cardiac 
depressant. 

Describe asafetida and outline its physiologic effects. 

Asaf etida is a gum-resin obtained by incision from the living 
root of ferula fetida, a perennial herb of the natural order 
Umbelliferse, native of Persia and Afghanistan. Its prin- 
cipal constituent is a sulphuretted volatile oil ; it also contains 
a gum and a resin. It is a powerful anti-spasmodic, a stimu- 
lant to the brain and nervous system, a stimulant expectorant ; 
also tonic, laxative, diuretic, diaphoretic, emmenagogue, 
aphrodisiac and anthelmintic in action. 

State the effect of the bromides on the respiration and 
on the action of the heart. What effect is the long con= 
tinued use of the bromides liable to produce on the mental 
faculties? 

The bromides reduce the number of the respirations, and the 
heart's action and force, and through diminishing the calibre 
of the arterioles they lower arterial tension. The continued 
use lessens the activity of the brain cells, producing somno- 
lence. 

State the source and the dose of creosote. 

Creosote is a mixture of phenols obtained during the distil- 
lation of wood-tar, preferably that derived from the beech. 
The dose is 1 to 3 minims well diluted. 



THERAPEUTICS AND MATERIA MEDIC A. 101 

In what diseases is conium used? 

It is especially indicated in diseases characterized by exces- 
sive motor activity. It is useful in chorea, paralysis agitans, 
in acute mania and delirium tremens; it is also employed in 
tetanus, asthma, whooping-cough and other spasmodic affec- 
tions. 

Define diaphoresis. Mention three diaphoretics and 
state the dose of each. 

Diaphoresis is a condition of sweating. Aconite, veratrum 
viride and the salicylate of sodium. The dose of aconitin is 
1-400 to 1-200 gr. The tincture of veratrum viride, 3 to 6 
drops. Salicylate of sodium, 10 to 20 gr. 

Mention ten drugs, the use of any one of which may 
cause skin eruption. 

Aconite, antimony, antipyrin, atropine, quinine, tar, tur- 
pentine, salicylic acid, mercury, opium. 

Write a prescription containing a stomachic to be used 
in alcoholism. 

R . Tinct. Nucis Vomicae f 3 ii 

Tinct. Gentianse Co f ^ iv 

M. Sig. — Teaspoonful before meals. 

Describe the therapeutic uses of chloral hydrate. 

It is of great value as a hypnotic and anti-spasmodic, but 
must be used cautiously, if at all, in persons with weak or fatty 
heart, atheroma or advanced pulmonary disease. It is of 
especial value in acute mania, delirium tremens and nocturnal 
epilepsy. 

What is the alkaloid of hyoscyamus? What is the dose 
of hyoscin hydrobromate for hypodermic use? 

It contains an alkaloid, hyoscy amine. The dose of hyoscin 
hydrobromate for hypodermic use is 1-200 to 1-50 gr. 

In what form is iodine most frequently administered 
internally? What is the antidote for free iodine? 

Potassium iodide. Starch is the antidote to free iodine, but 



102 THERAPEUTICS AND MATERIA MEDIC A. 

the stomach must be immediately evacuated, as the iodide of 
starch is not inactive. 



/ 



Mention three commonly used myotics. 

Eserin is the only myotic generally employed in ophthalmic 
practice. Opium and pilocarpine are two other drugs pos- 
sessing myotic effects. 

State the effects of alcohol and strychnin on the arte= 
rioles. 

Alcohol causes a dilatation of the arterioles, while strych- 
nin contracts the arterioles, except in very large doses, when 
it produces relaxation of the smaller vessels. 

Describe the symptoms and give the treatment of gastro* 
duodenitis. 

The symptoms of gastro-duodenitis partake of gastritis with 
an enteritis added, fever, gastric pain and vomiting, in addi- 
tion to which there may be colic and diarrhea. Simple catar- 
rhal jaundice will result from an extension of a gastro-duo- 
denitis into the common duct. The general symptoms of this 
condition are jaundice, loss of appetite, nausea, vomiting, a 
sense of fulness and constipation or irregular action of the 
bowels; there may also be slight fever. The treatment con- 
sists in saline aperients, which reduces the catarrhal inflam- 
mation, and second the use of such foods as do not require the 
bile to facilitate digestion. Skimmed milk, animal broths and 
egg albumen and copious drinking of water are advised. 

Mention the chief alkaloids and the therapeutic class of 
belladonna and of Calabar bean. 

Belladonna contains two alkaloids, the official atropine 
and belladonnine. Belladonna is a delirifacient. Calabar 
bean contains physostigmine and calabarine. It is a depresso- 
motor. 

Mention a soluble salt of lead. To what therapeutic 
class does bismuth subnitrate belong? 

Lead acetate. Bismuth subnitrate is classed with astrin- 
gents. 



THERAPEUTICS AND MATERIA MEDIC A. 103 

Mention the therapeutic uses of ergot of rye. What 
is the dose of the fluid extract of ergot? 

To produce uterine contraction, as a remedy in internal 
hemorrhages and in diarrhea and in dysentery. It has also 
been used in exophthalmic goiter and in acute cerebral con- 
gestion, meningitis and myelitis. The dose of the fluid ex- 
tract is 1 to 2 fluid drams. 

What is the physiologic action of Indian hemp? 

Cannabis indica, Indian hemp, produces in full doses a con- 
dition of mental exhilaration associated with hallucinations 
and disordered consciousness of time, locality and personality. 
This stage of excitment finally gives way to sleep, which may 
last for several hours. Sensation is perverted and benumbed, 
and before sleep is induced there is often more or less general 
anesthesia. The drug has little influence upon circulation 
and respiration. 

Mention three vegetable emmenagogues and state the 
dose of each. 

Ergot, the dose of the fluid extract is 1 to 2 drams ; savine, 
the dose of the fluid extract is 5 to 15 minims ; tansy, the dose 
of the oil is 1 to 3 drops. 

Define therapeutic incompatibility, chemical incompati- 
bility. 

Therapeutic incompatibility arises when two agents are 
administered together which oppose each other in their physi- 
ologic actions. Chemical incompatibility is due to the union 
of two or more substances in combination whereby chemical 
change results. 

Write a prescription containing dilute hydrochloric acid, 
syrup of milk, cherry and camphor water for a cough. 
Write on this prescription the dose for an adult. 

Jan. 1, 1903. Mr. John Smith. 

R . Acidi hydrochloric! dil f Z v 

Aquae camphorse f ^ i 

Syr. Pruni virginianae, q. s. ad f 5 iy 

M. Sig. — Teaspoonful every four hours. 

Wm. Jones, M. D. 



104 THERAPEUTICS AND MATERIA MEDICA. 

State the dose of (a) tincture of aconite, (b) fluid ex= 
tract of belladonna, (c) extract of conium. 

(a) 1 to 3 minims; (b) 1 to 2 minims; (c) 1 to 5 minims. 

State the name and the dose of each of two cardiac 
stimulants. 

Digitalis, dose of the tincture 10 to 20 minims; strophan- 
tus, dose of the tincture 3 to 10 minims. 

What are the therapeutic uses of the preparation of 
valerian? 

The preparation of valerian may be used for the anti-spas- 
modic effect in hysteria, nervous excitement and whooping- 
cough. 

In what pathologic conditions is uva ursi used? 

II va ursi is employed as an antiseptic and stimulating diu- 
retic in chronic inflammatory affections of the genito-urinary 
tract, such as pyelitis, cystitis and urethritis. 

State the name and the dose of each of five official pre- 
parations of opium. 

Opii pulvis, a half to one grain ; extract of opium, % to 1 
grain; tincture of opium, 10 to 30 drops; camphorated tinc- 
ture of opium (paregoric), 1 to 4 drams; wine of opium, 5 to 
10 drops. 

In what diseases are preparations of arsenic useful? 

Locally, arsenic is useful in lupus and epithelioma. It is a 
valuable alterative in diabetes, chronic rheumatism, phthisis 
and asthma. In malaria it ranks next to quinine ; in the sim- 
ple chorea of childhood it is almost a specific. It is of great 
value in anemic conditions. 

Describe the treatment of cerebro-spinal meningitis. 

Ice bags should be applied to the head and along the spinal 
column. Pain and restlessness may be relieved by morphia, 
bromides or chloral. Dry or wet cups over the spine are some- 
times useful. Iodide of potash may be administered routinely. 
Stimulants should be freely given as required. The pyrexia 



THERAPEUTICS AND MATERIA MEDIC A. 105 

should be controlled by sponging or the cold pack. During 
convalescence the iodides and tonics should be given, and blis- 
ters along the spine may be of service. 

State the name and dose of a drug belonging to each of 
the following classes: (a) emetics, (b) diuretics, (c) dia- 
phoretics, (d) cathartics. 

(a) Ipecac, the emetic dose of the fluid extract is 20 minims ; 
(b) digitalis, the dose of the infusion is 1 to 4 drams; (c) 
pilocarpus, dose of fluid extract is 10 minims; (d) jalap, the 
dose of the compound jalap powder is 20 to 40 grains. 

State the name and the alterative dose of a preparation 
of mercury capable of producing acute poisoning. Men= 
tion the chemical antidote for this preparation. 

Bichloride of mercury; dose 1-100 to 1-12 grain. In cases 
of poisoning by corrosive sublimate the stomach should be 
evacuated, the body temperature maintained and egg albumen 
given in large quantities as an antidote. 

How should asthma of cardiac origin be treated? 

The term cardiac asthma is applied to any shortness of 
breath which is the result of deranged cardiac action. The 
treatment is, of course, the treatment of the diseases which 
are responsible for it. Rest in bed is most important. The 
cardiac condition may indicate the need of digitalis, if, for 
instance, mitral regurgitation exists with loss of compensa- 
tion ; strychnine should be given if the heart muscle is weak ; 
nitro-glycerine may be given in the early stages of arterial 
sclerosis. The particular treatment will depend upon the 
condition of the circulation. 

Outline the treatment of uremia. 

The name uremia is .applied to a group of symptoms result- 
ing from the retention of toxic materials in the blood which 
should have been eliminated by the kidneys. Sweating should 
be encouraged by the use of hot-air or vapor baths. Catharsis 
should be induced by croton oil in 1-drop doses or by elate- 



106 THERAPEUTICS AND MATERIA MED1CA. 

rium in % grain doses. The renal engorgement may be 
relieved by a dry or wet cup to the loins. Venesection is 
indicated if the patient is robust and the pulse is strong. If 
the pulse is weak, heart stimulants should be administered. 
If convulsions occur, 30 to 40 grain doses of chloral may be 
given by the rectum, or pearl nitrite of amyl inhaled. 

Describe the treatment of apoplexy due to cerebral 
hemorrhage. 

During the attack the head and shoulders should be slightly 
elevated and an ice-bag applied to the head. Prompt catharsis 
should be produced by croton oil, in a little glycerin, placed 
on the back of the tongue. If the pulse be strong bleeding 
is indicated; if the pulse is feeble hypodermic injection of 
such stimulants as strychnine and ammonia should be em- 
ployed. Bed sores must be prevented by frequently changing 
the patient's position and sponging with alcohol the parts ex- 
posed to pressure. During convalescence those predisposed 
to such attacks should lead a quiet life and avoid excitement. 
Iodide of potash should be administered over a long period. 
After the primary rigidity has appeared in the affected mus- 
cles galvanism and massage may assist in restoring lost func- 
tions. 

State the official name and the minimum poisoning dose 
of (a) strychnine sulphate, (b) morphine sulphate, (c) 
chloral. State the antidote for each. 

(a) Strychnine sulphas. The fatal dose of strychnine 
sulphate is placed by Taylor at y 2 to 2 grains for an adult, 
but recovery has taken place after much larger doses. The 
antidotes are chloral hydrate, tannic acid and animal char- 
coal, (b) Morphine sulphas. Toxic dose depends on per- 
sonal susceptibility; % grain of morphine sulphate has killed 
an adult. Potassium permanganate is the best antidote if 
the morphine is in the stomach ; black coffee is also of value. 
(c) Chloral hydrate has caused death in several instances by 
a 30 grain dose. Atropine and morphine are its antidotes. 



THERAPEUTICS AND MATERIA MEDIC A. 107 

Write a prescription containing the tincture of the chlo= 
ride of iron and the chlorate of potash, with the proper 
dose for a child four years old. 

Jan. 1, 1903. John Smith. 

R . Potassii chloratis gr. xvi. 

Tiuctur&e ferri chloridi f 3 iss 

Ext. glycerrhizae 3 i 

Aquae, q. s. ad f J iv 

Sig. — A teaspoonful in water every three houts. 

John Jones, M, D. 

Criticise the following prescription: 

Tr. guaiac f^i 

Aq. cinnamon f ^ ii 

S. — A teaspoonful every four hours. 
5, 12, '99. Dr. J. 

This is an example of pharmaceutical incompatibility. An 
alcoholic tincture should not be prescribed with aqueous solu- 
tions, nor should resinous tinctures be combined with aqueous 
solutions. 

What is the source of carbo ligni? What are the thera- 
peutic uses of carbo ligni? 

Carbo ligni is charcoal derived from soft wood. It is em- 
ployed as an absorbent of foul gases and as a deodorant and 
disinfectant. Internally it is useful in affections of the 
gastro-intestinal tract associated with hyperacidity and flatu- 
lent distension. 

Give the dose of (a) caffein, (b) wine of ipecac, (c) 
tincture of veratrum viride. 

(a) 1 to 5 grains; (b) % to 6 fluid drams; (c) 3 to 6 drops. 

What are the therapeutic uses of convallaria majalis? 

Lily of the valley possesses actions analogous to digitalis, 

strengthening the heart and increasing the flow of urine; it 

does not disturb the stomach and is not cumulative in its 

effects. 

Define a general anesthetic. Mention three general 
anesthetics in common use. 

A general anesthetic is a drug which when inhaled suffi- 



108 THERAPEUTICS AND MATERIA MEDIC A. 

ciently produces complete unconsciousness and loss of sensa- 
tion, also lessened motor power. The general anesthetics 
mostly belong to the alcohols and ethers. Ether, chloroform 
and nitrous oxide are three examples of such drugs. 

Mention three principal salts of potassium used in medi = 
cine and give the dose of each. 

Potassium bromide, dose % to 2 drams ; potassium acetate, 
dose % to 1 dram ; potassium bicarbonate, dose % to 1 dram. 

Describe the therapeutic uses of oleum tiglii (a) exter= 
nally applied, (b) internally administered. 

Croton oil externally is used as a counter-irritant, and 
internally as a prompt hydragogue cathartic. 

Of what is duboisin an alkaloid? What are the physio- 
logic effects of duboisin? 

Duboisin is the alkaloid of duboisia; it is believed to be 
identical with hyoscyamine, and strongly resembles atropine. 
It is a prompt mydriatic. In moderate doses it induces quiet 
and refreshing sleep, and is not dangerous. When given in 
large doses it may produce vertigo, nausea or syncope. It is 
less irritating to mucous membranes than atropine. 

What are the therapeutic uses of nitro=glycerine? By 
what other names is nitro=g!ycerine known? 

Nitro- glycerine is also known as glonoin and trinitrin. It 
is valuable in certain forms of cardiac disease, especially in 
sudden heart failure, angina pectoris and fatty degeneration 
of the heart. It relieves the high arterial tension and the 
dyspnea of chronic nephritis. 

Define materia medica, therapeutics. 

Materia medica treats of the substances used as medicines 
and describes their origin, composition, chemical properties, 
modes of preparation and administration, also their physio- 
logic and toxicologic actions. Therapeutics comprises all the 
science and art of healing, including the use of medicines 
and all other agents given with the object of curing disease. 



THERAPEUTICS AND MATERIA MEDIC A. 109 

What are the therapeutic uses of sulphur? 

Externally it is of value as a stimulant and parasiticide in 
diseases of the skin of chronic type. Internally it is a mild 
laxative. It is of use both internally and externally in chronic 
articular rheumatism. 

Outline the general treatment of acute articular rheu- 
matism. Write a prescription containing at least two 
ingredients for an adult to relieve pain in acute articular 
rheumatism. 

Rest in bed is essential. The joints should be wrapped in 
cotton-wool. The nourishment should consist of milk, beef 
tea, broths and gruel. The free use of lemonade or mineral 
waters is advisable. The best remedies are the salicylates and 
the alkaline salts of potassium. The following is a useful 
combination : 

B . Sodii salicylat • 3 ii 

Potass, citrat 3 iii 

Glycerini. 

Tinct. cardamom, comp. aa f 3 ss 

Aquae, q. s. ad f % v. M. 

Sig. — A tablespoonful every two hours. 

What are the therapeutic uses of strophanthus? Men- 
tion the dose of the tincture of strophanthus. 

Strophanthus is a valuable cardiac tonic, and may be em- 
ployed in the class of cases in which digitalis is indicated. 
The dose of the tincture is 3 to 10 minims. 

Define official preparations as applied to preparations of 
medicinal agents. 

All of those drugs which have gained entrance to the Phar- 
macopoeia are termed official preparations. 

What are the standard units of the metric system of 
weights and measures? 

The unit upon which all calculations are based is the unit 
of length, the metre, which is the forty-millionth part of the 
circumference of the earth around its poles ; from this is de- 



110 THERAPEUTICS AND MATERIA MEDIC A. 

rived the unit of capacity, the litre, which is the cube of one- 
tenth part of a metre. From the litre is derived the unit of 
weight, the gramme, which is the one-thousandth part of the 
weight of a litre of distilled water at its maximum density. 

What are the therapeutic uses of cardamom? 

It is used as an agreeable aromatic for disguising the taste 
of other drugs and as a carminative. 

What is the common name of staphisagria? What are 
the therapeutic uses of staphisagria? 

Staphisagria, stavesacre, is an unofficial drug. It is a vio- 
lent emetic, cathartic and parasiticide. 

Mention the preparations of ammonia. What effect 
has ammonia on the heart? 

The official preparations are aqua ammonias, aqua ammonias 
fortior, linimentum ammonias, spiritus ammoniae, spiritus 
ammonias aromaticus. Moderate doses of ammonia increase 
the strength and rapidity of the heart, and this effect is pro- 
duced by a direct stimulation of the heart and its accelerator 
nerves. 

Write a compound prescription for an adult containing 
iron, quinine and opium in pill form for neuralgia. 

Jan. 1, 1903. John Smith. 

B . Pulveris opii gr. x 

Ferri sulphatis exsiccatse, 

Quininse sulphatis aa gr. xx. 

M. et fiant in pilule No. 20. 

Sig. — One every four hours. John Jones, M. D. 

Define tincture and spirits. 

Tinctures are alcoholic solutions of medicinal substances. 
Spirits are alcoholic solutions of volatile substances, which 
may be solids, liquids or gases. Tinctures, with the exception 
of the tincture of iodine, are made from non-volatile bodies. 

Mention three drugs used to accelerate the action of the 
heart and give the dose of some preparation of each. 

Atropine, dose of atropine sulphate 1-150 to 1-75 grain. 



THERAPEUTICS AND MATERIA MEDIC A. Ill 

Nitro- glycerine, dose 1-100 grain. Ammonia, dose of the 
aromatic spirits 20 to 60 minims. 

Give the treatment of obstinate hiccough. 

Bythmic traction of the tongue will often arrest obstinate 
hiccough. Ether as a spray to the epigastrium for ten min- 
utes, then to the site of the phrenic in the neck, is also ad- 
vised. Morphine hypodermically, either alone or in combi- 
nation with atropine, has sometimes proven effective. 

Describe the treatment of bronchopneumonia. 

The room should be well ventilated and kept at a tempera- 
ture of 70°. At the onset a laxative should be administered, 
such as calomel, in % grain doses every hour until the bowels 
are moved. The diet should be liquid or semi-liquid. Stim- 
ulants should be given when required. Stimulating expec- 
torants are nearly always indicated, such as carbonate of 
ammonia, squills or senega; strychnine is often of great ser- 
vice as a respiratory and cardiac stimulant. Nervous symp- 
toms, such as restlessness, delirium, etc., will often be relieved 
by a cold pack. Hyoscine or bromide of potassium may, 
however, be indicated. Should resolution be delayed counter- 
irritants may be used. Tonics are necessary during conva- 
lescence. 

What is the physiologic effect of cocaine on the ocular 
conjunctiva, the pupil of the eye and the salivary and 
sweat glands. 

Cocaine dropped upon the conjunctiva causes dilatation of 
the pupil and profound anesthesia of that membrane; it also 
produces partial paralysis of accommodation, slight lachry- 
mation and sometimes temporary ptosis. - It lessens the 
secretion of the salivary glands and the sweat glands. 

Write a prescription for a syphilitic adult containing 
corrosive sublimate and iodide of potassium in solution. 

January 1, 1903. For John Jones. 

R . Hydrargyri chloridi corrosivi gr. i 

Potassii iodidi gii 

Tincturse gentianse comp. f ^ iii. 

M. et Sig. — A teaspoonful thrice daily after meals. 

John Smith, M. D. 



112 THERAPEUTICS AND MATERIA MEDIC A. 

What are the therapeutic uses of tar? 

Tar is used as a stimulating expectorant and as a stimulant 
to the skin in certain chronic inflammatory diseases. 

What are the physiologic effects and therapeutic uses 
of chromic acid? 

Chromic acid exerts a powerful caustic effect upon all ani- 
mal tissue. It has a destructive action upon micro-organisms, 
and from the readiness with which it parts with its oxygen it 
rapidly decomposes organic matter, and so serves as a disin- 
fectant. It is not employed internally. It is a useful escha- 
rotic for destroying corns, warts, syphilitic vegetations and 
the like. 

Give the source and state the uses of thymol. 

Thymol is a phenol obtained from the volatile oil of thyme 
and certain other volatile oils. Thymol is used as a disin- 
fectant in the form of a wash, as an ointment in chronic skin 
diseases, and internally as an efficient antiseptic. 

What is the dose of croton oil as a cathartic? What are 
the contraindications to its use? 

The dose is % to 2 drops, given in glycerine or olive oil. 
It is contra-indicated when either debility, organic obstruc- 
tion or inflammatory conditions of the stomach or bowels 
exist. 

What are the physiologic effects and therapeutic uses of 
cubebs? 

Cubebs is an aromatic stomachic and a stimulant diuretic 
in small or medium dose, but large amounts derange digestion 
and may act as gastro-intestinal irritant. Its constituents 
are eliminated by the bronchial mucous membranes, the skin 
and the kidneys, stimulating and disinfecting the genito- 
urinary passages, increasing the bronchial mucus, sweat and 
urine, and frequently causing an urticarial or vesicular erup- 
tion. It increases the action of the heart and the vascular 
system and promotes the menstrual discharge. Cubeb is used 
in the acute stage of gonorrhea, in chronic cystitis and chronic 



THERAPEUTICS AND MATERIA MEDIC A. 113 

bronchitis. It is applied in powder form in hay fever, chronic 
nasal catarrh and follicular pharyngitis. 

Mention the therapeutic uses of carbolic acid except as 
an antiseptic. 

It is used as a caustic, local anesthetic, as an antiemetic and 
carminative. 

What is the treatment of scabies? 

Sulphur, styrax and naphthol are efficient local applications 
as ointments. 

An excellent formula is the following : 

Sulphur sublimat g j 

Balsam Peruviana 3 ss 

Adipis gj. 

M. et Sig. — Rub in thoroughly twice a day. 

How does an antagonist differ from an antidote? 

Antagonists are agents which oppose each other in their 
physiologic action, and may be employed against each other 
as counter poisons to neutralize their effects upon the organ- 
ism. They do their work in the blood and tissues after ab- 
sorption, and are especially available against poisons admin- 
istered hypodermically, in which case antidotes are useless. 
Antidotes affect a poison so as to remove it from the body or 
alter its character before absorption, and thereby prevent its 
toxic action on the organism. They do their work in the 
alimentary canal or in the respiratory passages. (Potter.) 

Name and describe the methods of introducing medicines 
into the circulation. 

Medicines may be introduced into the circulation by various 
routes, including the mouth, the stomach, the rectum, the res- 
piratory tract, the veins and arteries, the subcutaneous cel- 
lular tissues and the skin. Intravenous medication is only 
used in emergencies where immediate action is desired. Saline 
solution is the usual remedy introduced by this route. The 
rectum will absorb any substances applied in the form of an 
enemata or suppositories. The hypodermic method is the 
introduction of medicines into the organism by injecting them 
8 



114 THERAPEUTICS AND MATERIA MEDIC A. 

into the subcutaneous tissue, from which they are quickly- 
absorbed by the lymphatic and capillary vessels. The respi- 
ratory tract admits of the rapid absorption of medicinal sub- 
stances through its extensive blood supply, especially by 
inhalation. The stomach is the most convenient organ for 
the absorption of medicine. The remedies find their way into 
the current of the circulation through the walls of the gastro- 
intestinal blood vessels and the lacteals. 

How do strophartthus and digitalis differ in physiologic 
action? 

Compared with digitalis, strophanthus is a powerful cardiac 
stimulant, differing from digitalis in not producing vaso- 
motor constriction of the arterioles. It reduces the pulse, 
lowers, body temperature somewhat, is not cumulative in 
action, and does not cause any gastro-intestinal disturbance. 
It is a diuretic by direct stimulation of the renal circulaton, 
and has power over rigors by its rapid cardiac action, stop- 
ping them and preventing their recurrence. 

Mention the official turpentines. State from whence 
they are obtained. 

There are two official turpentines, terebinthina, a concrete 
oleoresin from Pinus palustris, the yellow pine, and other 
species of pinus, natural order Coniferce, Terebinthina 
canadensis, a liquid oleoresin obtained from Abies balsamce, 
the balm of Gilead. 

Compare opium and belladonna as to action on the heart. 

Medicinal doses of belladonna quicken the pulse and raise 
the arterial pressure ; the quickening of the pulse results from 
depression of the inhibitory nerves and stimulation of the 
accelerators. The increased blood pressure is due to stimu- 
lation of the vasomotor centers and the heart itself. Toxic 
doses paralyze the heart. Opium in moderate doses has little 
effect upon the circulation. Large doses, however, stimulate 
the inhibitory nerves, centrally and peripherally, and thus 
slow the pulse ; at the same time the latter becomes full and 



THERAPEUTICS AND MATERIA MEDIC A. 115 

strong from stimulation of the heart or its contained ganglia, 
and possibly also from stimulation of the vasomotor centers 
in the medulla. Toxic doses finally paralyze both the heart 
and vagi and produce a rapid feeble pulse. 

What are the therapeutic uses of ammonium carbonate? 

It is used principally as a stimulant in low fevers, like 
typhoid, and in acute pulmonary diseases associated with 
cardiac and respiratory weakness, such as croupous pneu- 
monia, catarrhal pneumonia and capillary bronchitis. 

Define solvent. Mention three principal solvents. 

Solvent is the term applied to the liquid before the sub- 
stance is added to it, by which addition after the operation is 
completed the combined preparation is called a solution. The 
chief solvents are water, alcohol and glycerine. 

What is the source of aloes? By what part of the intes= 
tinal tract is it eliminated? 

Aloes is the inspissated juice of the leaves of the Aloe soco- 
trina and other species of aloe. It acts chiefly on the lower 
half of the large intestine. 

Describe the physiologic action of alum. In what patho= 
logic conditions is alum useful? 

Alum is an astringent, coagulating the albumen and stimu- 
lating muscular contraction. At first it excites the flow of 
saliva and then diminishes it. It coagulates pepsin and 
arrests digestion, stops peristalsis and usually causes consti- 
pation, although sometimes it produces diarrhea. Although 
coagulating albumen even in weak solution, it enters the 
blood, arrests secretion, especially those of mucous surfaces, 
and stops capillary hemorrhages. It is used locally as an 
astringent in chronic catarrh, leucorrhea, gonorrhea, hemor- 
rhoids, bed sores, colliquative sweats, etc. The dried powder 
is escharotic, destroying granulation and warty growths. 
Alum is used as an emetic in smaller doses in gastric catarrh, 
gastralgia, lead colic, etc. 



116 THERAPEUTICS AND MATERIA MEDIC A, 

Mention the ingredients of (a) TuIIy's powder, (b) 
Dover's powder. 

(a) Tully's powder is the compound powder of morphine. 
It has of morphine sulphate 1 part to 19- of camphor and 20 
each of liquorice and calcium carbonate. Dover's powder 
contains 10 parts ipecac, 10 parts of powdered opium and 80 
parts sugar of milk. 

Why is atropine combined with morphine when the 
latter is administered? What is the dose of atropine when 
combined with morphine? 

Atropine has long been regarded as the physiological an- 
tagonist of opium. It especially combats the depressing 
effect of opium on the circulation. The hypodermic dose of 
atropine sulphate when combined with morphine is 1-150 
grain. 

What is the physiologic action of veratrum viride on the 
circulation? 

It lessens greatly the force and rate of cardiac pulsation 
and reduces arterial tension by depression of the vasomotor 
center and of the heart itself. 

Give the physiologic action of senna and state what part 
of it is used in medicine. Where does senna grow most 
abundantly? 

The leaflets of Cassia cutifolia and of Cassia angustifolia; 
the former grows in Egypt and the latter in southern India. 
Senna is a brisk cathartic, producing in three or four hours 
after its ingestion copious watery stools. It acts by increas- 
ing both peristalsis and the intestinal secretion. It is ab- 
sorbed by the circulation. 

Describe bromism and state how it is produced. 

Bromism is produced by the continuous administration of 
the bromide. The condition is characterized by anemia, fetor 
of the breath, gastric disturbance, diminution of the reflexes, 
unsteady gait, impairment of tactile sensibility, abolition of 






THERAPEUTICS AND MATERIA MEDIC A. Ill 

sexual function, mental depression, failure of memory, som- 
nolence and a general eruption of acne. 

What are the therapeutic uses of sodium salicylate? 

It is of value as an antipyretic, as an anti-rheumatic and 
anti-neuralgic. It is of the greatest service in pleurisy with 
serous effusion, and is often useful in diabetes. "When given 
early it will often abort tonsillitis. It is of service as a gastro- 
intestinal disinfectant. 

Give the dose of (a) pilocarpine, (b) elaterin. 

(a) The dose of pilocarpine hydrochlorate is 1-20 to 1-3 
grain, (b) the dose of elaterin is 1-60 to 1-10 grain. 

Describe the therapeutic uses of hydrochloric acid. 

It is employed internally in the treatment of dyspepsia 
associated with subacidity. It is useful as a refrigerant and 
digestant in the continued fevers. In conjunction with 
strychnia it is of value in intestinal indigestion. The strong 
acid is also an escharotic. 

What are the principal uses of chloride of lime? To 
which ingredient does it owe its energy? 

Calcium chloride is of value as an internal remedy in the 
various manifestations of the strumous diathesis. It often 
causes the resolution of glandular enlargement, and is of value 
in chorea, lupus and eczema. It owes its energy to the cal- 
cium contained. 

What are the symptoms of opium poisoning? 

Unless the dose has been very large there is at first a stage 
of excitement, in which the imagination is stimulated and the 
feelings exalted. This stage is soon followed by depression; 
the patient becomes stupid and drowsy, and finally falls 
asleep. The sleep deepens into coma, the pulse becomes slow 
and full, the pupils contracted, the respiration slow and 
heavy and the face suffused. At this time it is still possible 
to arouse the patient by a loud noise, flagellation or shaking. 
In the third stage the coma becomes absolute, the pulse rapid 



118 THERAPEUTICS AND MATERIA MEDIC A. 

and feeble, the breathing shallow and irregular, the skin 
moist, the muscles relaxed, the pupils dilated, and finally 
death results from paralysis of the respiration. 

Mention the remedy which will arrest the secretion of 
milk and state how it should be employed. 

Camphor used locally by inunction in saturated solution of 
olive oil is efficient in checking the secretion of milk, as is 
belladonna. 

Give the methods and the therapy of cold water treat* 
ment applied externally. 

Cold water may be applied in the form of cloths saturated 
^vith it, by sponging, bathing or packing with ice. The cold 
bath is the most frequently employed. A bath-tub half full 
of water at 70° F. is kept in readiness at the bedside of the 
patient, and whenever the temperature rises above 102.4° F. 
the patient is wrapped in a sheet and carefully lifted into the 
tub. While in the bath cold affusions should be applied to 
the head, and the body should be constantly subjected to gen- 
tle friction and massage, so as to bring new relays of blood to 
the surface. A stimulant is often necessary to counteract 
the shock. After remaining in the water 15 to 20 minutes 
he is placed in a dry sheet and covered with a light blanket. 

What are the therapeutic uses of alcohol? 

The question of the advisability of employing alcohol in 
medicine has given rise to never-ending controversy. Many 
give it a high place, while others do not employ it at all. The 
external and local use of alcohol includes many applications 
of its antiseptic, refrigerant and rubefacient qualities. In 
the form of champagne it is especially valuable in controlling 
vomiting. A single dose of whiskey or brandy is an efficient 
combatant of fainting or of collapse. In fevers it acts as an 
antipyretic, a food, and promotes sleep. It is well to with- 
hold it until the first sound of the heart becomes feeble and 
dull, and then to use it boldly. It is of especial value in the 
treatment of pneumonia, typhoid fever and snake bite. 



THERAPEUTICS AND MATERIA MEDIC A. 119 

Mention the physiologic effects of bryonia. What is the 
dose of the tincture of bryonia? 

Bryonia is a pure irritant, setting up local inflammation 
wherever it is applied. It has a vesicant action on the skin, 
and is violently irritant to the serous and mucous membranes. 
It produces cerebral congestion, with frontal headache and 
vertigo. It is a drastic purgative and a powerful diuretic. 
It causes in full dose hepatic and renal congestion, vesical 
tenesmus and depression of the heart's action. The dose of 
the tincture is 5 drops to y 2 ounce. 

State the dose of (a) aconitin, (b) picrotoxin. 

(a) 1-400 to 1-200 grain, (b) 1-100 to 1-20 grain. 

Give the composition and state the uses of lotio hydrar= 
gyri flava. 

Yellow wash is a favorite application for syphilitic sores. 
It is prepared by adding 18 grains of corrosive sublimate to 
10 ounces of lime water, producing the yellow oxide. 

Give indications for the internal use of bichloride of 
mercury. State the dose of bichloride of mercury for 
internal use. 

It is of value in anemia, as an absorbent in diphtheria, as 
a general alterative, and is highly prized as an anti-syphilitic 
remedy in the secondary and tertiary stages. The dose is 
1-100 to 1-12 grain. 

What are the principal therapeutic uses of the salt of 
lead? 

Lead salts are chiefly used as astringents and hemostatics. 
The acetate is an efficient internal styptic. The nitrate is of 
value locally in epithelioma and unhealthy granulations. The 
iodide is employed locally to enlarged lymphatic glands and 
in chronic skin affections. The carbonate is only used exter- 
nally to protect irritated surfaces, such as intertrigo, etc. 

Explain the constipating action of opium. 

Opium arrests all the secretions except the milk and the 



120 THERAPEUTICS AND MATERIA MEDIC A. 

sweat, and retards the digestive juices. The biliary and 
glycogenic functions of the liver are affected and metabolism 
greatly reduced. Its constipating action is produced chiefly 
by stimulation of the inhibitory nerves of the intestines 
through the splanchnics. 

Mention the symptoms of poisoning by phosphorus. 

Toxic doses of phosphorus produce, after the lapse of a few 
hours, a garlicky taste in the mouth, thirst, intense abdominal 
pain, obstinate vomiting, restlessness and prostration. The 
ejected materials contain mucus, bile, and occasionally dis- 
integrated blood, and are luminous in the dark. At the end 
of 24 or 36 hours the symptoms gradually subside and the 
patient feels comparatively comfortable, but soon jaundice 
develops, the vomiting and pain return, the liver becomes 
enlarged and painful, the urine contains albumen, bile, hypo- 
phosphoric acid and crystals of leucin and tyrosin. The 
tongue is coated, the breath offensive, the belly distended, 
the bowels either constipated or loose and the stools clay- 
colored and sometimes phosphorescent. Death is generally 
preceded by grave nervous symptoms, such as headache, de- 
lirium, convulsions, stupor and coma. When recovery follows 
convalescence is protracted and tedious. 

Write a prescription containing a sedative and an ex- 
pectorant for a bronchial cough in a three=year=o!d child. 

January- 1, 1903. For Walter Smith. 

R . Tinctura opii camphoratse gtt. lxiv 

Potassii citratis o ii 

Syrupi pruni virginianse, q. s. ad f 5 i y - 

M. Sig. — Teaspoonful every four hours. 

Wm. Jones, M. D. 

In what pathologic condition is jaborandi useful? 

It is of use in dropsy, especially of renal origin, in uremia, 
inflammation of the serous membranes, in diabetes insipidus, 
rat is contra-indicated when the heart's action is weak. It 
v.: useful in the form of a lotion for alopecia. 



THERAPEUTICS AND MATERIA MEDIC A. 121 

What is the dose of carbolic acid for internal administra* 
tion? What are the chemical antidotes for carbolic acid? 

Dose 14 to 2 grains well diluted. The chemical antidote is 
any soluble sulphate which forms with the carbolic acid in- 
gested the harmless sulpho-carbolate. 

What is the common name of lactucarium? State the 
physiologic action of lactucarium. 

Lettuce. Lactucarium is feebly hypnotic and somewhat 
sedative and diuretic. It acts feebly. The syrup is a good 
vehicle for expectorants and anti-spasmodics. 

What is the physiologic action of colchicum? 

Emetic, diuretic, diaphoretic, a drastic purgative and car- 
diac depressant, gastro-intestinal irritant. In small doses it 
is an emeto-cathartic. 

What serious results may ensue from indiscriminate use 
of acetanilid? 

A toxic dose destroys the ozonizing function of the blood 
and forms methyl-hemoglobin, causes fatty degeneration of 
the heart, liver and kidneys in animals poisoned by it. When 
administered continuously or in too great dose it is apt to 
cause subnormal temperature, cyanosis and collapse. 

Mention the therapeutic uses of hydrocyanic acid. 

It is used for its anti-spasmodic and sedative effects, and is 
indicated in vomiting, whooping-cough, asthma, vertigo, gas- 
tralgia, etc. It has been used to advantage in acute mania 
and melancholia, and locally as an anti-pruritic. 

What is cascara sagrada? State the dose of the fluid 
extract of cascara sagrada. 

It is the bark of Rhamnus purshiana, California buckthorn. 
The dose of the fluid extract is y 2 to iy 2 drams. 

What are the therapeutic uses of tincture of capsicum 
internally administered? State the dose of the tincture 
of capsicum. 

It is employed chiefly as a stomachic and carminative. A 



122 THERAPEUTICS AND MATERIA MEDIC A. 

weak solution of the tincture is also a much used gargle in 
sore throat with relaxed uvula. The drug is especially valu- 
able in alcoholic gastritis and obstinate constipation. The 
dose of the tincture is 5 to 10 minims. 

What part of aconite is used in medicine? What is the 
alkaloid of aconite? 

Aconite is derived from the root of the aconitum napellus. 
Its most important alkaloid is aconitine. 

Write a prescription for corrosive sublimate to be used 
as a parasiticide. 

January 1, 1903. For John Jones. 

Hydrargyri bichoridi gr. ii 

Unguenti petrolati f 3 i. 

M. et Sig. — Use locally. John Smith, M. D. 

How is liquor ammonii acetatis prepared? In what 
conditions is this preparation useful? 

Spirit of mindererus is prepared by neutralizing dilute 
acetic acid with ammonium carbonate; it should be freshly 
made, as it soon deteriorates. It is an active diuretic if the 
body be cool, and a diaphoretic if the body be warm. In 
wineglassful doses it will counteract many of the immediate 
effects of alcohol. 

Give the therapeutic uses of sodium phosphate. 

In doses of % ounce it is a mild purgative. It has been 
recommended in catarrhal jaundice and cholelithiasis. 

State the ingredients and uses of sulphur ointment. 

Sulphur ointment is made up of 30 parts of sublimed sul- 
phur and 70 parts of benzoinated lard thoroughly mixed. 
Sulphur ointment is used in certain forms of skin diseases 
and as a means of administering sulphur when it is not well 
borne by the stomach. 

Give the composition and the chief use of lotio hydrar- 
gyri nigra. 

Black-wash is prepared by adding 30 grains of calomel to 



THERAPEUTICS AND MATERIA MEDIC A. 123 

10 ounces of lime water, producing the black oxide, and is used 
as an application to syphilitic sores. 

What are the therapeutic uses of Pulsatilla? 

Some therapeutists regard the drug as of no value whatever ; 
others claim good effects from its employment as an emmena- 
gogue, a diuretic and diaphoretic; it is also a cardiac and 
vascular sedative, and possesses some antipyretic action. 

Where is quassia indigenous? What part of the plant 
is used in medicine? 

The "West Indies. The wood is used. 

What is the common name of the ferrous sulphate? 
Give the chief uses of ferrous sulphate. 

Copperas: it is impure ferrous sulphate. It is chiefly used 
to make the dry sulphate and other preparations. It is some- 
times employed as a tonic astringent. 

Describe the physiologic action and the therapeutic use 
of guarana. 

Guarana has similar actions to those of coffee, the active 
principle of both plants being perhaps identical. It may be 
used in migraine, in convalescence in acute diseases, in diar- 
rhea of phthisis, etc. 

Give the composition of Vienna paste (pasta caustica 
Viennensis). 

It is a grayish-white deliquescent powder consisting of 
equal parts of potassa and lime rubbed together. 

Explain the distinction between physiologic action and 
the therapeutic use of medicinal agents. 

The physiologic action of a drug is its effect upon the 
economy in health, and includes its action upon the nervous 
centers, respiration, circulation and metabolism. From its 
physiologic action is deduced its therapeutic indication or 
employment in certain diseased states. 



124 THERAPEUTICS AND MATERIA MEDIC A. 

Define a mydriatic. Give three examples, with the dose 
for the local application in each case. 

Mydriatics are agents which produce dilatation of the 
pupils. Atropine is used locally in solutions of 8 grains to 
the ounce. Homatropine, in strength of 4 grains to the 
ounce. Cocaine locally in a 5 per cent, solution. 

Define germicides, parasiticides. 

Germicides are agents that destroy germs, as solutions of 
bichloride of mercury, permanganate of potash, carbolic acid, 
etc. Parasiticides are agents which are destructive to para- 
sites; the principal parasiticides are mercurial ointment, sul- 
phur and acetic acid. 

What results of combining silver nitrate and creosote? 

An explosive compound, which is white in color, without 
odor, and has the appearance of an emulsion. 

Describe the therapeutic uses of zinc sulphate and of 
zinc oxide. 

Zinc sulphate is an excellent astringent in weak solutions. 
It is used as an injection in gonorrhea and in sub-acute and 
chronic conjunctivitis. It is a prompt emetic in narcotic 
poisons, and in doses of 1 or 2 grains in pill form is useful in 
chronic diarrhea and dysentery. Zinc oxid^ is used exter- 
nally as a mild astringent and sedative in burns, acute ulcers 
and acute inflammatory skin diseases. ' Its internal use is not 
general. But it may be employed in night sweats, epilepsy, 
asthma and hysteria. 

What symptoms are produced by toxic doses of tartar 
emetic? 

Pain, vomiting, diarrhea, with watery stools and collapse, 
motor and sensory paralysis and suppression of the urine. 

Mention two remedies commonly used to increase intes= 
tinal peristalsis. 

Senna and rhubarb. 



THERAPEUTICS AND MATERIA MEDIC A. 125 

What are the therapeutic uses of buchu? 

Chronic affections of the genito-urinary mucous membranes, 
lithiasis, prostatic affections, atonic dyspepsia and chronic 
rheumatism. 

What is the ultimate effect on the heart's action of 
medicinal doses of belladonna? 

Following the ingestion of belladonna the heart rate is at 
first slowed, but soon becomes rapid and vigorous, and the 
arterial tension is increased; this is accomplished by stimula- 
tion of the cardiac sympathetic and paralysis of the pneumo- 
gastric, thus stimulating the accelerator apparatus while 
lessening the inhibitory. 

Compare the strength of dilute hydrochloric acid with 
that of the absolute acid. What is the dose of the former? 

Dilute hydrochloric acid is a 10 per cent, solution of the 
absolute acid in water. Its dose is 3 to 10 minims. 

How do styptics and hemostatics differ? Give an ex= 
ample of each. 

These are agents which arrest bleeding, styptics being those 
which are applied locally, as alum, and hemostatics those which 
are administered internally, as gallic acid. 

What part of zingiber is used in medicine? What are 
its therapeutic uses? 

The rhizome. The official preparations are fluid extract, 
tincture, syrup, troches and the oleoresin. It is employed as 
a carminative and as an adjunct to purgative medicine to pre- 
vent griping; the syrup is commonly employed as a flavoring 
adjuvant. 

Define pharmacy. 

Pharmacy is the art of selecting and preserving medicines 
and preparing them for administration. 

How do therapeutic agents act to promote waste? 

Destructive metamorphosis of the tissues is promoted by 
alteratives and astringents. The manner in which alteratives 



126 THERAPEUTICS AND MATERIA MEDIC A. 

act has never been determined. We know that of such 
drugs as mercury and iodine, the former being endowed 
with the power of breaking up newly deposited fibrin and 
disorganizing syphilitic deposits, and the latter acts ener- 
getically upon the lymphatic system and promotes absorption. 

Mention the principal therapeutic application of anti= 
pyrin. 

Antipyretic, analgesic, antiseptic, as a local anesthetic and 
to diminish secretion, as an anti-galactagogue. 

What is the dose of curare for hypodermic use? What 
are the antagonists of curare? 

1-20 to y Q grain. Strychnine, atropine, and more effective 
still, artificial respiration. 

What is codein? State the dose of codein. What are 
the advantages of codein over opium? 

Codein is an alkaloid of opium, differing from morphine in 
having the radical CH 3 replacing an atom of hydrogen. It is 
less irritating to the digestive tract than opium. Its dose is 
% t0 % grain- 
Mention the therapeutic uses of creosote. 
Locally as an anesthetic and antiseptic. Internally as an 
antiseptic, in chronic gastric catarrh, in diarrhea, dysentery 
and phthisis. 

What is the common name of hamamelis? State the 
dose of the fluid extract of hamamelis. 

Witch-hazel. The dose of the fluid extract is 1 minim to 1 
dram. 

What part of buchu is used in medicine? State the dose 
of the fluid extract of buchu. 

The leaves. Dose of the fluid extract 10 minims to 1 dram. 

State the therapeutic uses of arsenic, (a) applied exter- 
nally, (b) administered internally. 

Externally it is used as a depilatory and as an escharotic. 



THERAPEUTICS AND MATERIA MEDIC A. 127 

Internally it is used as a tonic, astringent to the intestinal 
canal, as an anti-spasmodic in nervous diseases, and as an 
alterative. 

What is the official name of tartar emetic? State the 
dose of tartar emetic. 

Antimonii et potassii tartras. Dose 1-16 to % grain. 

What are the uses of cantharis (a) externally applied, 
(b) internally administered? 

Externally it is employed as a vesicant and internally as a 
stimulant to the genito-urinary tract. 

What is pepo? State its therapeutic use. 

Pumpkin-seed. It is used as an anthelmintic against tape- 
worms. 

Describe the physiologic action and the therapeutic uses 
of scammonium. 

Scammony is a powerful irritating hydragogue cathartic. 
It may be used in combination with other cathartics in obsti- 
nate constipation. 

Mention the preparations of ergot and gfve the dose of 
each preparation. 

The extract of ergot, dose 5 to 20 grains ; the fluid extract, 
dose 1 to 2 drams ; the wine, dose 2 to 4 drams. 

Define hematics. Mention two principal hematics. 

These are medicines which increase the quantity of hematin 
in the blood. They consist chiefly of iron and manganese and 
their compounds. 

What are the physiologic effects of iodoform internally 
administered? State the therapeutic uses of iodoform 
when externally applied. 

In small doses internally iodoform is considered to be a tonic 
and alterative. If taken over a protracted period it may cause 
profuse salivation. In toxic d,oses it causes pyrexia, then 
headache, quick and feeble pulse, marked anxiety and restless- 
ness; collapse and death may suddenly supervene. Locally 



128 THERAPEUTICS AND MATERIA MEDIC A. 

its action is anesthetic and powerfully antiseptic. It is one 
of the best agents to prevent decomposition, and it destroys 
the germs of putrefaction and of disease, but must be carefully 
employed. 

Give the dose of (a) liquor potassii arsenitis, (b) liquor 
sodii arsenitis. 

(a) 2 to 8 minims freely diluted, (b) 2 to 8 minims freely 
diluted. 

Define emulsion. 

Emulsions are liquid preparations containing an insoluble 
medicinal substance, as an oil or a resin, in a state of minute 
subdivision, and suspended by the aid of some viscid excipi- 
ent, as gum, which may be contained in the medicinal ingre- 
dient itself or be added by the pharmaceutist. 

Where is the habitat and what are the physiologic 
effects of digitalis? 

It grows wild in Europe and is cultivated in this country. 
The dominant action of digitalis is on the circulation. In 
therapeutic doses it slows the pulse and raises the blood pres- 
sure. The slowing of the pulse results from a prolongation 
of the diastole, and this in turn is due to stimulation of the 
vagi or inhibitory nerves. The increased blood pressure is 
due to a powerful stimulant effect on the heart and to a con- 
traction of the arterioles resulting indirectly from stimulation 
of the vasomotor center and directly from the action of the 
drug on the vessel wall. Toxic doses quicken the pulse by 
paralyzing the vagi and lower the arterial pressure by causing 
a powerful systolic contraction so that the diastole becomes too 
imperfect to permit the ventricles to be completely filled. 
Therapeutic doses have no effect on the nervous system, but 
toxic doses lessen the reflexes, first by stimulating Setsche- 
now's inhibitory centers and later by depressing the spinal 
cord. It requires toxic doses to influence the respiration, 
and then slowing occurs. Large doses occasionally produce 
nausea, vomiting and diarrhea. In health digitalis has little 



THERAPEUTICS AND MATERIA MEDIC A. 129 

or no diuretic action. AVhen the urine is diminished from 
embarrassment of the circulation it produces free diuresis, 
which is attributed to its effect on the heart and vessels, and 
not to a direct influence on the secreting structure of the 
kidney. 

What parts of gossypium are used in medicine? 

The bark of the root is official, as gossypii radicis and the 
hairs of the seed, as gossypium purincatum. 

What is the important alkaloid of erythroxylon and what 
is its principal therapeutic use? 

Its alkaloid, cocain, is allied to caffein, but is more power- 
ful, and its proportion in the leaves of the plant varies greatly 
in the different samples which occur in commerce. Its chief 
use is that of a local anesthetic. 

Name the official preparations of bismuth and give the 
dose of each. 

Bismuth citrate, used only for pharmaceutical purposes; 
bismuth and ammonium citrate, dose 1 to 5 grains; bismuth 
subcarbonate, dose 5 to 30 grains; bismuth subnitrate, dose 
5 to 30 grains. 

What is the physiologic action of iris? 

Iris when fresh is actively purgative, emetic and diuretic, 
producing severe nausea and prostration. 

What is the dose of (a) potassium iodide, (b) ammonium 
iodide, (c) sodium iodide? 

(a) Potassium iodide, 5 to 60 grains; (b) 2 to 10 grains; 
(c) 5 to 60 grains. 

From what is koumiss made and what are its therapeutic 
uses? 

Koumiss is an effervescing fermented liquor originally pre- 
pared by the Tartars from mares' milk, but now imitated with 
cows' milk by adding sugar of milk, fermenting in an open 
tank, skimming off the casein and butter, then bottling during 
active fermentation. Koumiss is an invaluable article of 
9 



130 THERAPEUTICS AND MATERIA ME DIG A. 

diet in many wasting diseases, especially tuberculosis. It is 
of great benefit in dyspepsia, the diarrheas of children, con- 
valescence from acute maladies, chronic affections of the kid- 
neys, chronic bronchitis and other cachexiae. 

What is the proportion of mercury in hydrargyrum cum 
creta? What is the dose? 

Thirty-eight per cent, mercury. Dose, y 2 to 10 grains. 

Compare the therapeutic uses of pepsin and pancreatin. 
How are these remedies prepared? 

Pepsin is the name for the hypothetical digestive principle 
of gastric juice. Pancreatin is a mixture of the enzymes 
naturally existing in the pancreas of warm-blooded animals. 
Pepsin is usually obtained from a solution prepared by di- 
gesting the mucus scraped from the rennet-bags of sheep or 
the stomach of the pig in acidulated water for several days. 
It is then precipitated by sodium chloride, lead acetate or 
alcohol. Pancreatin is usually obtained from the fresh pan- 
creas of the hog. Pepsin is employed in cases of gastric indi- 
gestion; while pancreatin is indicated in intestinal indigestion. 

Describe the therapeutic action of spigelia. What are 
its therapeutic uses? 

Spigelia, pink root, is anthelmintic against the round worm, 
and is usually administered with senna. In large doses it is 
an uncertain cathartic, and may produce serious symptoms, 
including vertigo, dimness of vision, dilated pupils and con- 
vulsions. 

What are the therapeutic uses of cannabis and what is 
the dose of the tincture of cannabis indica? 

It is used as a sedative and soporific as a substitute for 
opium in such conditions as chronic bronchitis, phthisis, in the 
dyspnea of asthma, and in the restlessness of chronic neph- 
ritis. As an analgesic it is useful in neuralgia and migraine. 
It is also employed in mania, delirium tremens, and in some 
forms of dysmenorrhea and menorrhagia. The dose of the 
tincture is 10 to 60 minims. 



THERAPEUTICS AND MATERIA MEDIC A. 131 

What is the composition of hydrargyri iodidum rubrum? 

It is a red crystalline powder prepared by the double de- 
composition between potassium iodide, 5 parts, and mercuric 
chloride, 4 parts. 

Where is the cinchona tree indigenous? What part of 
the tree is used in medicine? 

It is a native of the eastern slope of the Andes. The bark. 

Name three drugs used to retard the heart's action and 
state the dose of some preparation of each. 

Aconite, dose of the tincture, 1 to 3 minims; antimony, 
dose of tartar emetic 1-16 to 1 grain ; veratrum viride, dose of 
the tincture 3 to 6 drops. 

Describe the symptoms of hydrargyrism. 

The first symptoms of chronic mercurial poisoning are 
fetid breath, swollen and spongy gums having a bluish line 
along their margin, stomatitis, sore and loosened teeth, sali- 
vation. Anorexia, diarrhea and fever follow, also ulceration, 
and in some cases even gangrene of the lips and tongue. 
There is destruction of tissue and various nervous disturb- 
ances. The patient becomes emaciated, suffers from head- 
ache, insomnia, neuralgia and tremor, a vesicular or pustular 
eruption appears, and finally there follow coma and con- 
vulsions. 

Give the common name and state the physiologic effects 
of mentha piperita. 

Peppermint. It is an aromatic stimulant, also carmina- 
tive and anti-spasmodic. It is used in the form of menthol, 
as an antiseptic and local anesthetic. Peppermint is em- 
ployed internally for the relief of nausea and colic and as a 
carminative. It is an agreeable corrigent for combination 
with purgatives to prevent griping. 

Of what is iodoform a preparation and what is the dose 
for internal administration? 

Iodoform contains from 94 to 97 per cent, of iodine. Dose, 
1 to 5 grains. 



132 THERAPEUTICS AND MATERIA MEDIC A. 

What are the sources of salicylic acid? 

Salicylic acid is an organic acid existing naturally in com- 
bination in various plants, but is generally prepared synthet- 
ically from carbolic acid. 

Give the source and describe the uses of lanolin. 

Lanolin is the purified fat of the wool of sheep mixed with 
not more than 30 per cent, of water. It is useful in chronic 
skin diseases where there is infiltration and where a pene- 
trative action is required for medicaments locally applied. 

How do oleates and ointments differ? 

Oleates are liquid solutions of metallic salts, or alkaloids 
in oleic acid intended for external administration. Oint- 
ments are soft, fatty mixtures of medicinal agents with a 
basis of lard, petrolatum, etc. They are intended for appli- 
cation to the skin by inunction, and have a melting point 
which is below the ordinary temperature of the human body. 

What are the therapeutic uses of acetanilid administered 
internally? Has it any uses when locally applied? If so, 
what are they? 

It is used internally as an antipyretic and an analgesic and 
anti-spasmodic. It is extensively employed in surgical prac- 
tice as a dry dressing for wounds, etc. 

Give the composition and common name of compound 
effervescing powder. 

Seidlitz powder. Each powder contains 40 grains of so- 
dium bicarbonate, 120 grains of potassium and sodium tar- 
trate mixed in one paper, and of tartaric acid 35 grains in 
another paper. They are dissolved separately in water and 
the solution poured together. 

Describe linum and give its medical preparations and 
uses. 

Flaxseed is the seed of linum usitatissimum. It contains 
15 per cent, of mucilage in the epithelium, also 30 to 40 per 
cent, of fixed oil in the embryo. Linseed oil is official. Lin- 



THERAPEUTICS AND MATERIA MEDIC A. 133 

seed tea is in common use, but is not official. Carron oil, a 
favorite application for burns, consists of equal parts of lin- 
seed oil and lime water. Linceed is demulcent, emollient, 
expectorant and diuretic. The oil is laxative in doses of 1 
ounce. The ground seed is used in making the linseed 
poultice. 

What are the symptoms of iodism? How may it be 
prevented while the use of the iodide is continued? 

The symptoms of iodism are anemia, emaciation and mental 
depression. There is frontal headache, ptyalism, a saline 
taste in the mouth, dysphagia, temporary impotence and an 
eruption of acne on the face and limbs. The iodide of 
potash may be prescribed in combination with tincture of 
cinchona or with Fowler's solution, which prevents the iodic 
eruption to some extent. If the iodides are given freely 
diluted in water the toxic effects are less likely to be produced. 

Give the common name of hydrastis and describe its 
therapeutic uses. 

The common name is golden seal. It is used chiefly as a 
stomachic tonic and antiperiodic, a mild laxative and an 
antiseptic. It is of value in catarrhal inflammation of the 
gastro-intestinal and genito-urinary tract and as a local alter- 
ative and antiseptic application. 

Write the following prescription by the metric system: 

Potassii bicarb. 3J dr. 

Acidi acetici 7 fl. dr. 

Aquae 3 fl. oz. 

Potassi bicarb grammes 13.608 

Acidi acetici cubic c. c. 26. 

Aquse cubic c. c. 89. 

What are the possible dangers from the use of salol in 
large doses? 

Salol breaks up in the body into salicylic acid and carbolic 
acid. It is apt to produce the symptoms of carbolic acid 
poisoning. 



134 THERAPEUTICS AND MATERIA MEDIC A. 

Give the medical name and the official preparation of 
lignum vitae. 

Guaiaeum. The official preparations are the tincture of 
guiac and the ammoniated tincture. 

What are the therapeutic uses of manganese? 

The salts of manganese, especially the permanganate of 
potash, are used in anemia, in irregularities of menstruation, 
as an antidote against opium or morphine in the stomach and 
locally, as an antiseptic and oxidizing agent. The dioxide 
is a good remedy in amenorrhea, gastrodynia and pyrosis, 
and in the form of an ointment for many skin diseases. 

How is the peroxide of hydrogen prepared? What are 
its therapeutic uses? 

The peroxide of hydrogen of commerce is the solution of 
hydrogen dioxide. It consists of water to which nascent 
oxygen has been presented, whereby an additional atom of 
the oxygen has entered into combination with the hydrogen, 
producing H 2 2 • This solution contains, when freshly pre- 
pared, 3 per cent, of the pure dioxide, corresponding to about 
10 volumes of available oxygen. This preparation is a non- 
toxic antiseptic. It is employed as a gargle or spray in 
quinsy, croup, diphtheria, scarlet fever, ozena, and for the 
purpose of cleansing wounds. It may possess some value as 
an intestinal antiseptic on account of the fact that it is a 
valuable oxidizing agent. 

What are the therapeutic uses of uva ursi? What part 
of this plant is used in medicine? 

Bearberry is an astringent tonic, and is feebly diuretic. 
The leaves are employed. 

What is the common name of oleum morrhuae? On 
what physiologic effect does its therapeutic use depend? 

Cod-liver oil. The action of cod-liver oil is like that of 
any other fat except that it is more easily assimilated than 
any member of the class. Its beneficial effects, therefore, 
are derived solely from its food value. 



THERAPEUTICS AND MATERIA MEDIC A. 135 

What is the composition of linimentum calcis? For 
what is it principally used? 

Carron oil consists of equal parts of lime water and linseed 
oil, and is employed chiefly in burns. 

State the dose of (a) tincture of quassia, (b) caffein, 
(c) fluid extract of ergot, (d) infusion of digitalis, (e) 
sulphate of strychnia. 

(a) 1 to 2 drams; (b) 1 to 5 grains; (c) 1 to 2 drams; (d) 
1 to 4 drams; (e) 1-40 to 1-20 grain. 

What action on the heart has valerian in full doses? 
State the therapeutic uses of valerian. 

In full doses it increases the action of the heart and raises 
the temperature. The oil in large doses lowers the blood 
pressure and slows the pulse. Valerian is used in hysteria 
for the flatulence of infants and nervous subjects, also for 
coughs of nervous type, in whooping cough, diabetes insipi- 
dus and in delirium with vital depression. 

Where is jalap indigenous? What part of it is used in 
medicine? 

Jalap is a Mexican plant. The root is used. 

What are the therapeutic uses of juniper? In what 
cases is it contra=indicated? 

Juniper is a stomachic tonic, diaphoretic, diuretic and 
aphrodisiac. It is contra-indicated in all patients suffering 
from acute inflammation of the kidneys. 

Mention the salts of silver used in medicine and give 
the dose of each. 

Silver nitrate, dose % to % grain. Silver cyanide; this 
is not used in medicine except in the preparation of hydro- 
cyanic acid. Silver iodide, dose % to 1 grain. Silver oxide, 
dose % to 2 grains. 

Describe the therapeutic uses of (a) water and (b) min= 
eral water. 

Cold water or ice has many external applications of value 



136 THERAPEUTICS AND MATERIA MEDIC A. 

in the treatment of disease. As a wet pack it is nsed in ton- 
sillitis and diphtheria. The cold baths and the cold wet pack 
are the best methods of obtaining an antipyretic effect in 
fevers. Cold or ice water is applied to the head in acnte 
cerebral congestion. Locally in orchitis, the uterus in post- 
partum hemorrhage, etc. Hot water externally is most 
effective in reducing local congestion and setting up resolu- 
tion of local inflammation. The hot wet pack is highly es- 
teemed in inflammations of the chest. The vaginal hot-water 
douche is serviceable in catarrhal conditions of the vaginal 
and cervical mucous membrane and congestive, swollen or 
neuralgic conditions of the ovaries, tubes and adjacent tis- 
sues. Vapor and Turkish baths are used in chronic kidney 
disease and as diaphoretics generally wherever a diuretic 
effect is desired. Internally, water is of value as a diuretic, 
and if hot as a diaphoretic. Mineral waters are esteemed 
most highly when they are of the class possessing aperient 
and purgative properties. Depending upon the composition 
of these waters, they may be of value in chronic rheumatism, 
diabetes, obesity, syphilis, metallic poisoning, constipation, 
etc. 

Where is the cinnamon tree indigenous? Mention the 
active principle of cinnamon and give its dose. 

Ceylon. The active principle is a volatile oil, the dose of 
which is 10 to 20 grains. 

What therapeutic uses has chloroform other than an 
anesthetic? 

It is used in intestinal colic and serous diarrhea, as a car- 
minative and as a sedative in cases of obstinate cough. 

What is the dose of tincture of belladonna and what 
indications show that its physiologic effect has been 
obtained? 

Five to thirty minims. Medicinal doses quicken the pulse 
and large doses stimulate respiration. Dryness of the mucous 
i.;3mbrane and skin and dilatation of the pupil will indicate 
the physiologic effect has been reached. 



THERAPEUTICS AND MATERIA MEDIC A. 137 

For what purposes and effects is strychnia frequently 
used in formulae for cathartics? 

Strychnia stimulates the muscular coat of the intestine, 
increasing peristalsis, and thus acts as a purgative, but it 
restrains the frequent discharges due to atony of the bowels. 

Give the formula of normal salt solution. 

Normal salt solution consists of 0.65 per cent, of sodium 
chloride in water. 

What effect has pilocarpus on (a) the heart, (b) the skin, 
(c) the salivary glands? 

(a) Pilocarpus is a cardiac depressant by stimulation of 
the vagus ends; (b) it causes prompt and profuse perspira- 
tion, and (c) salivation. 

What is the source from which eserin is obtained? How 
and for what purpose is eserin principally used? 

Eserin is one of the two alkaloids of physostigma. It is 
used locally in solution of 2 grains to the ouuce in the eye to 
contract the pupil and reduce intra-ocular tension. Inter- 
nally it is efficient in constipation due to torpor of the bowel, 
in which condition it is usually combined with belladonna 
and nux vomica. 

Describe the therapeutic uses and the dangers of chloral 
hydrate. How does a toxic dose of chloral hydrate affect 
body temperature? 

Chloral is chiefly used to promote sleep and to check spasms. 
It must be administered with care on account of the danger 
of the patient becoming addicted to the chloral habit. It is a 
distinctly dangerous drug, as it lowers the blood pressure and 
body temperature. Cardiac and respiratory weakness are 
contra-indications to its use. Toxic doses lower body tem- 
perature. 

What is the common name of guaiacum? What are 
the therapeutic uses of guaiacum? 

Its common name is lignum vitce. Guaiacum is diaphoretic, 



138 THERAPEUTICS AND MATERIA ME DIG A. 

expectorant and alterative, also laxative and purgative, ac- 
cording to the dose administered. 

What are the therapeutic uses of limonis succus? 

Lemon juice is used as a refrigerant and diuretic mixture 
in fever. For acidity of the stomach and as a common 
remedy in obesity. Locally it is used as an antipyretic, anti- 
pruritic and as a gargle. It is also used for flavoring pur- 
poses. 

Define anthelmintic and name the remedies of this class. 

Anthelmintics are agents which destroy or expel worms 
inhabiting the intestinal canal. They are classed according to 
the worm against which they are each most efficient. For 
thread worms the principal remedies are quassia, alum, sodium 
chloride, lime water and the vegetable astringents. For 
round worm, santonin, spigelia, chenopodium. For tape 
worm, filix mas, kamala, kousso, pepo and granatum. The 
principal vermifuges are the purgatives, castor oil, jalap and 
scammony. 

What are the therapeutic uses of resorcin? 

Resorcin is employed as an antipyretic and antiseptic. A 
3 per cent, solution gives good results in ulcer of the stomach, 
cancer and other morbid conditions. It is also used locally as 
a remedy in skin diseases. 

Name the official preparation and state the therapeutic 
uses of santalum album. 

Oil of sandal wood is official. It is extensively used in 
chronic bronchitis and catarrhal conditions of the genito- 
urinary tract. 

How is collodium made? What are the preparations of 
collodium? 

Collodium is made by dissolving 3 parts of pyroxylin in 
75 parts of ether and 25 parts of alcohol. There are flexible 
collodium, styptic collodium and cantharidal collodium. 
Collodium is used as a protective covering for superficial 
burns, ulcers, wounds and slight cuts. Styptic collodium 



THERAPEUTICS AND MATERIA MEDIC A. 139 

has many uses as a hemostatic and protective, while the 
cantharidal form is a convenient epispastic. 

Give the common name and the therapeutic uses of 
hematoxylon. 

Log-wood. Log-wood is mildly astringent, its properties 
depending upon the tannin contained in it. It is not irritat- 
ing, and is useful in diarrhea and hemorrhages in young 
children. It has been employed as a hemostatic in bleeding 
of the lungs and hemorrhages from the uterus and intestines, 
also as an astringent injection. 

On what physiologic action does the therapeutic use of 
elaterin depend? 

Elaterin is the most powerful of the hydragogue cathar- 
tics, causing profuse watery stools, and when given in large 
doses great prostration and gastro-intestinal irritation, nau- 
sea and vomiting. 

State the source of ichthyol and give its uses in medicine. 

Ichthyol is prepared from the product of the distillation 
of bituminous rocks from the Tyrol, which contain fossil 
fishes. It is useful in certain chronic skin diseases, particu- 
larly eczema and psoriasis. It is extensively used externally 
for its antiseptic and alterative properties in rheumatism, 
erysipelas and lymphatic enlargements. Combined with gly- 
cerin, it is valuable, locally applied, in the various inflamma- 
tory affections of the female genital organs. 

What are the therapeutic uses of aconite? Give the 
dose of the fluid extract of this drug. 

Aconite is used locally in neuralgia; internally in hyper- 
emesis, in acute inflammation, such as tonsillitis, bronchitis 
and pneumonia, in excessive hypertrophy of the heart, in 
nervous palpation, in the tachycardia of exophthalmic goiter 
and in active cerebral congestion with high arterial tension. 

What part of scoparius is used in medicine? What 
alkaloid is derived from scoparius? 

The tops oi.cytisus scoparius. Its alkaloid is sparteine. 



140 THERAPEUTICS AND MATERIA MEDIC A. 

Give the common name of taraxacum and state what 
part of this plant is used in medicine. 

Dandelion. The root is used in medicine. 

What is the physiologic action of tincture of the chlo= 
ride of iron upon the kidneys? 

The tincture of the chloride is considered diuretic. 
Give the chief source and the dose of gallic acid. 

It is prepared from a paste of powdered galls by ferment- 
ing for six weeks, boiling and reboiling in water, filtering and 
crystallizing. Dose, 5 to 15 grains. 

Give the dose of hyoscin for hypodermic use. For what 
purpose is hyoscin used? 

The dose of hyoscin hydrobromate hypodermically is 1-200 
to 1-50 grain. Hyoscin is a cerebral and spinal sedative, a 
powerful hypnotic. It is employed as an anodyne when 
opium is contra-indicated. 

What is an excipient? Give examples. 

Excipients are substances which give form and consistence 
to prescriptions, and serve as vehicles for the exhibition of 
the other ingredients. Examples are syrups, acacia and the 
various flavoring agents, such as syrup of lemon. 

Describe the technique of venesection. 

The patient having been placed in a semi-recumbent posi- 
tion, the arm should be constricted three or four inches above 
the elbow by a few turns of a roller or a twisted handkerchief ; 
if this is not sufficient to render the veins prominent, the arm 
may be rubbed for a few minutes from below upwards. A 
large vein having been selected, it should be incised by a 
thumb-lancet or a spring-lancet in a direction oblique to the 
long axis of the vessel. The amount of blood abstracted will 
depend entirely upon the pulse, which should be carefully 
observed during the operation, and when it lessens in force 
and becomes more compressible the bleeding must be sus- 
pended. 



THERAPEUTICS AND MATERIA MEDIC A. 141 

Define glucosides and give two examples. 

Glucosides form a group of organic principles existing in 
plants, and are generally neutral in character. Examples 
are salicin, obtained from willow and other barks, and glycyr- 
rhizin, from liquorice root. 

What is the most active laxative ingredient in pulvis 
glycyrrhizae compositus? 

Senna. 

By what methods do antipyretics act? Give an example 
of one that acts by each method. 

Antipyretics reduce the body temperature in fever: (a) 
by lessening the production of heat; (1) by diminishing tis- 
sue change; (2) reducing the circulation, or (b) promoting 
the loss of heat; by (3) dilating the cutaneous vessels; (4) 
producing perspiration and (5) abstracting heat from the 
body. Examples of antipyretics acting in the order named 
are as follows: Quinine (1), digitalis (2), carbolic acid (1 and 
3), antipyrin (1 and 4), cold sponging (5). 

Indicate the common name and give the preparations 
of serpentaria. 

Virginia snake-root. The preparations are the fluid ex- 
tract and the tincture. It also is one of the components of 
compound tincture of cinchona. 

What are the therapeutic uses and the official prepara= 
tions of oleic acid? 

Oleic acid is used only in making the oleates. Three 
preparations are official, the oleate of mercury, the oleate of 
veratrine and the oleate of zinc. 

What is the antidote for strychnine? 

Chloral hydrate. 

Describe the manner of making barley water as food for 
the patient. 

It may be made as follows : Grind y 2 ounce of pearl barley 



142 THERAPEUTICS AND MATERIA MEDIC A. 

in a coffee mill, add 6 ounces of water, boil 20 minutes, add 
salt and strain. 

What are the therapeutic uses of the preparations of 
silver? 

The nitrate is the most soluble of the silver salts; it is 
antiseptic, astringent, hemostatic, irritant, and a limited es- 
charotic, also anti-phlogistic, anti-spasmodic and tonic. The 
oxide is the least irritant, and does not discolor the skin so 
quickly. Internally it has been used in gastric neuralgia, 
irritable dyspepsia, pyrosis, gastric and pulmonary hemor- 
rhages, dysmenorrhea, menorrhagia, to check profuse sweat- 
ing, to control vomiting, and in diarrhea depending on reflex 
nervous irritation. The iodide is similarly employed. 

How would you distinguish chemically between ether 
and chloroform? 

Ether is ethyl oxide (C 2 H 5 ) 2 0. In its absolute form it is 
not official, the strongest preparation containing 4 per cent, 
of alcohol and some water. Chloroform is the true chloride 
of methyl, CHC1. . 

Name four drugs used in the treatment of chronic inter- 
stitial nephritis. 

Nitro- glycerin, Basham's mixture, caffein and magnesium 
sulphate. 

Give the therapeutic uses of caffein. 

Cardiac stimulant in cardiac and renal dropsy, and alone 
or in combination with antipyrin or the bromides in nervous 
headache and migraine. 

Describe the physiologic action of aconite. 

It is a powerful depressant of the sensory nerve ends, the 
nervous and muscular apparatus of the heart and respiration, 
and the spinal nervous system. It is also antipyretic, dia- 
phoretic and diuretic. 



THERAPEUTICS AND MATERIA MEDIC A 143 

Name the official preparations and doses of digitalis, 
cascara sagrada, ipecacuanha and strophanthus. 

Digitalis, the extract, dose % to % grain, the fluid extract 
1 to 2 drops, the infusion 1 to 4 drams, the tincture 5 to 20 
drops. Cascara sagrada, the fluid extract, dose % to 1 dram. 
Ipecacuanha, the fluid extract emetic dose 20 minims, 
Dover's powder 5 to 10 grains, the syrup emetic dose 4 to 6 
drams, troches, each contain % grain, troches of morphine 
and ipecac, contain 1-36 grain morphia, 1-12 grain ipecac, 
wine of ipecac, emetic dose 4 to 6 drams. Strophanthus, the 
tincture, 3 to 10 minims. 

What are the medicinal uses of hydrastis? 

It is an unreliable hemostatic in uterine hemorrhage, and 
is more valuable for its astringent action when locally applied 
in catarrhal conditions of the genito-urinary tract. 

Name four efficient hypnotics and give the source and 
dose of each. 

Sulphate of morphine derived from opium, dose % to 14 
grain; hyoscine, the alkaloid of hyoscyamus, dose of the ex- 
tract % to 2 grains ; chloral hydrate obtained from the union 
of water with trichlor- aldehyde, dose 10 to 20 grains; sul- 
phonal, a synthetic product obtained by the oxidation of a 
mixture of ethyl-mercaptan and acetone, dose 15 to 30 grains. 

Write a prescription for (a) a collyrium, (b) a supposi= 
tory, and (c) a mouth wash. 

( a ) R. Acidi borici gr. x 

Aquse camphorse 

Aquse destillatse aaq. s. ad f % j 

Sig. — Fifteen drops in both eyes thrice daily. 

( b ) R. Pulveris opii gr. j 

Iodoformi gr. j 

Olei theobrom. q. s. 
Fr. in suppositoria No. 1. 
Sig. — Use on retiring. 

( c ) Be . Potassii chloratis gr. lxxx 

Aquse laurocerasi f o viij 

M. S. — Use as mouth wash, 



144 THERAPEUTICS AND MATERIA MEDIC A. 

Name five antiseptics and tell in what proportions each 
should be diluted for surgical purposes. 

Bichloride of mercury, 1 to 1000. Permanganate of pot- 
ash, 25 grains to the pint. Boric acid, 15 grains to the ounce. 
Carbolic acid, 5 per cent, solution in glycerine and water. 
Peroxide of hydrogen, the full strength of the official prepa- 
ration is 3 per cent. 

Describe the physiologic action of hyoscin and name a 
physiologic antidote. 

It is a cerebral and spinal sedative and powerful hypnotic, 
directly depressing the higher function of the brain and 
affecting the heart but feebly. Tannin and morphine. 

Give the composition of the official compound cathartic 
pill. 

Compound extract of colocynth, 130 grains; abstract of 
jalap, 100 grains; mild chloride of mercury, 100 grains; 
gamboge, 25 grains. These quantities properly prepared 
make 100 pills. 

Describe two safe and efficient emetics for a child and 
give dose for a child two years old. 

Alum, in 15-grain doses; syrup of ipecac, y 2 dram. 

Describe two escharotics and tell how you would apply 
them. 

Nitrate of silver applied in the form of lunar caustic is an 
efficient superficial escharotic ; carbolic acid is escharotic, and 
should be used in strong solution, 1 to 10. 

Write a correct prescription containing nitrate of silver. 

Argenti nitratis gr. iij 

Gum Tragacanth, q. s. 

Ft. — In pil no. xii. 

Sig.— One before meals. John Jones, M. D. 

State the direct and indirect effect of pilocarpine in drop- 
sical effusion. 

It causes prompt and profuse perspiration and salivation, 



THERAPEUTICS AND MATERIA MEDIC A. 145 

increases the bronchial and lachrymal secretion, and some- 
times causes serous diarrhea. Full doses cause a decrease 
in arterial tension. The elimination of urea is greatly in- 
creased, but not the quantity of the urine. 

What are the physiological effects of nux vomica on the 
nerves and circulatory system. 

It is a powerful stimulant of the spinal cord, especially the 
motor columns. In toxic doses it produces spinal convulsions. 
Small amounts stimulate the brain and increase the mental 
powers. In moderate doses the heart is stimulated and the 
arterial pressure raised by stimulation of the vasomotor cen- 
ter in the medulla. 

What is wrong with the following prescription? 

R . Argentse nitratis drams, one. 

Sodi chloridum drams, four. 

Syrupus lemonis, q. s. ounces, four. 

Sig. — Take a tablespoonful after meals in water. 

Argentce should read argenti; sodi chloridum should read 
sodii chloridi; syrupus lemonis should read syrupus limonis. 
This prescription affords the example of a pharmaceutical 
incompatibility. Nitrate of silver should not be compounded 
with sodium chloride, for there results the insoluble chloride 
of silver. 

Write for an adult a complete prescription for a diarrhea 
mixture containing three remedies and the excipient. 

ft . Cretee preparatse 3 ii 

Tincturse catechu % ss 

Tincturse opii Tlllxxx 

Aqua cinnamomi ad f % viii 

M. Sig. — Two teaspoonfuls every four hours. 

Name the official preparations of belladonna and the dose 
of those used internally. 

Extr actum belladonce foliorum alcoholicum. dose 1-12 to 
y± grain ; tinctura belladonnce foliorum, dose 5 to 30 min. ; 
extr actum belladonnce radicis fluidum, 1 to 2 min.; emplas- 
trum belladonnce; unguentum belladonnce. 
10 



146 THERAPEUTICS AND MATERIA MEDIC A. 

Write a prescription containing oil of sandal wood and 
at least one other constituent for chronic cystitis. 

January 1, 1903 For William Smith. 

R . Olei santali. f ^ i 

Salol g j 

Ft. in Capsules no. xii. 
Sig.— One after meals' Wm. Jones, M. D. 

Define narcotics, anesthetics and sedatives and give an 
example of each. 

Narcotics are agents which lessen pain and produce sleep 
or stupor; example, opium. Anesthetics are agents which 
temporarily destroy sensation; they are both general and 
local; example, ether as a general anesthetic and chloride of 
ethyl as a local anesthetic. Sedatives are agents which exert 
a soothing influence on the system by lessening functional 
activity, depressing motility and diminishing pain; example, 
the bromides. 

Treat a case of opium poisoning; also give the thera- 
peutic uses of opium. 

The stomach should be emptied by the stomach pump or a 
stimulating emetic, like sulphate of zinc or mustard. Pre- 
vious to this, however, if the opium is in the stomach, solution 
of permanganate of potash should be administered freely; as 
a chemical antidote strong coffee should be given, and the 
patient should be aroused by flagellation, douching, or forced 
walking. Atropine and strychnine should be given hypoder- 
mically. The temperature should be maintained by the ex- 
ternal application of heat. In therapeutics opium is used 
internally to produce sleep, to relieve pain, to lessen nervous 
excitement, to promote diaphoresis, to check hemorrhage and 
to support the system. Externally it is used as a sedative. 

Name five emetics and give the dose of each. 

Alum, dose, 1 to 4 drams; mustard, dose, 1 to 4 drams; 
ipecac, dose, of the fluid extract, 15 to 30 minims; apomor- 
phine, dose, 1-10 to 1-5 grain ; sulphate of zinc, dose, 10 to 30 

grains. 



THERAPEUTICS AND MATERIA MEDIC A. 147 

Name the preparations of secale cornutum and give the 
dose of each. 

Secale cornutum is the ergot of rye. Its preparations have 
been given above. 

What are the advantages and disadvantages in the use 
of chloroform as an anesthetic and what are the signs indi= 
cative of danger in the patient? 

Inhalations of chloroform produce sensations which are 
rather agreeable than otherwise, while the first stage of ether 
anesthesia is decidedly unpleasant. Chloroform produces 
anesthesia more quickly than ether., and in certain cases this 
is an advantage. It is, however, much more dangerous than 
ether. Its dangerous symptoms are: (1) respiration becomes 
stertorous or shallow, (2) sudden dilatation of the pupils, (3) 
signs of cardiac failure. Chloroform produces much less 
subsequent vomiting. 

Define briefly but clearly serum therapy. 

Serum therapy properly means the prophylactic and cura- 
tive treatment of certain acute infectious diseases by the sub- 
cutaneous injection of a blood serum containing an antitoxin 
specific to the particular disease. As generally used, how- 
ever, this term includes the treatment of the same disorders 
by the toxins produced by attenuated cultures of their re- 
spective microbes ; but these toxins, though sometimes grown 
on blood serum, may be cultivated on other media, and are 
never administered in a serum, as the antitoxins invariably 
are. The antitoxins at present employed in serum therapy 
are those of diphtheria, tetanus, tuberculosis, erysipelas, pneu- 
monia, cholera, syphilis, plague and typhoid fever, but only 
the first three have come into anything like general use. 
(Potter.) 

What official preparations are derived from the willow? 

Salicin is a glucoside obtained from several species of the 
willow. The various salicylates are prepared from salicin as 
well as salicylic acid. The salix nigra is the source of the 
fluid extract of this willow which is on the market. 



148 THERAPEUTICS AND MATERIA MEDIC A. 

What active principles are found in digitalis? What 
are the official preparations of petroleum? 

Digitalin, digit oxin, digitalein, digitonin and digitin. Pe- 
trol 'alum is a mixture of the hydrocarbons obtained from 
petroleum. The official preparations are petrolatum li- 
quidum, petrolatum molla and petrolatum spissum. 

Give the physiologic action and therapy of saline pur- 
gatives. 

This group includes the neutral salts of metals - of the alka- 
line or alkaline earths. They stimulate the intestinal glands 
to increased secretion, and by their low diffusibility impede 
re-absorption, causing an accumulation of fluid in the intes- 
tinal tract. This, partly from the effect of gravity and partly 
by gentle stimulation of peristalsis excited by distension, 
reaches the rectum and produces a copious evacuation. Mag- 
nesium sulphate and sodium sulphate are the typical salines. 
They should be given in plenty of water and during active 
movement (as in walking) in order to produce their best 
effects. 

Name three drugs used in the treatment of intermittent 
fever. State how each controls this disease. 

Quinine exerts a specific influence in all malarial infections 
by reason of its power to prevent the development of the 
Plasmodium to which malaria is due. A 10-grain dose of the 
sulphate should be given in the sweating stage, and again five 
hours before the expected time of the next paroxysm. In the 
intervals arsenic is of more value; its therapeutic action is 
due to the fact that it is a valuable anti-periodic, as well as 
tonic and alterative. Mercury is also of value for its hema- 
tinic and alterative properties. 

Describe the treatment of intestinal indigestion. 

Under this term a variety of conditions have been described 
dependent upon various causes, but it is usually restricted to 
acute or chronic intestinal catarrh. When this is dependent 
upon causes residing in the stomach the existing gastritis must 



THERAPEUTICS AND MATERIA MEDIC A. 149 

be first treated. A course of calomel and soda is of value ; 
this may be followed by the administration of pancreatin, 
which will aid digestion. Proper measures of diet and exer- 
cise are important. Charcoal in 10-20-grain doses is useful. 

Name four drugs incompatible with tannic acid. Name 
two incompatible with hyoscyamus. 

Tartar emetic, lead acetate, silver nitrate and hydrochloric 
acid are incompatible. The hydroxid of potassium with tan- 
nin and sodium with hyoscyamus. 

What doses of antitoxin are used for a child five years 
old ill with diphtheria? What would be the prophylactic 
dose for the same child? 

1500 units. 500 units. 

Correct the following prescription: 

R . Atropiae Sulphatis grs. iss 

Potas. Iodidi J oz. 

Infusae Digitalis in. oz. 

Elix. Simpl q. s. ad. 2 fl. oz. 

M. S. — Teaspoonful in water four times a day 

Potassium iodide is best given alone. The dose of atropine 
is much too great. It should be about 1-100 grain to each 
dram. Atropice sulphati should read Atrppince sulphatis. 
In the last drug Infusce should read Infusi. 

Name three drugs incompatible with belladonna and two 
incompatible with pilocarpine. 

The hydroxids of potassium, sodium and lithium are in- 
compatible with belladonna, and these are also incompatible 
with pilocarpine, as are the salts of the metals generally. 

Give the usual dose of creosote and tell how it is best 
administered. 

It is prescribed in 1 to 5 minim doses, well diluted in wine 
or whiskey. 

Name four official pills and give the principal ingre= 
dients of each. 

Pills with aloes contain purified aloes and powdered soap; 



150 THERAPEUTICS AND MATERIA MEDICA. 

pills of asaf etida contain asafetida and powdered soap ; com- 
pound pills of iron contain myrrh, carbonate of sodium, sul- 
phate of iron and syrup; compound rhubarb pills contain 
rhubarb, aloes, myrrh and oil of peppermint. 

Define tinctures, extracts and ointments and tell as a 
rule how many drops of a tincture are in a fluid dram. 

Tinctures are alcoholic solutions of medicinal substances, 
and with the exception of tincture of iodine are made from 
non-volatile bodies. Extracts are solid or semi-solid prepa- 
rations obtained by evaporating solutions of vegetable prin- 
ciples. Ointments are soft, fatty mixtures of drugs with a 
basis of lard, petroleum or fixed oils. The number of drops 
to a fluid dram of tinctures varies widely; 110 may be con- 
sidered an average. 

Write a complete prescription containing at least three 
drugs for acute bronchitis in an adult. Use no abbrevia- 
tions. 

January 1, 1903 For Mrs. Watson. 

Be . Tincturae opii camphorata f sj v 

Tincturse nucis vomicae f \ ii 

Misturse glycyrrhezae composite f'5iv 

M. S. — Teaspoonful every four hours. John Jones, M. I). 

In the treatment of syphilitic node or gumma state which 
should be used, a mercurial or an iodide, and give the rea- 
son therefor. 

In the treatment of the tertiary lesions of syphilis the 
iodides and mercury, the so-called mixed treatment, is often 
employed, the object being to get the greatest possible alter- 
ative effect. The appearance of a gumma, especially of the 
nervous system, demands energetic drug treatment. Iodides 
should be given in the largest possible doses, and mercury 
should be administered by inunction. 

Give the reason which would determine the employment 
of a vegetable or a mineral astringent in acute inflamma= 
tory conditions. 

Vegetable astringents check secretion and hemorrhages and 
cut short local inflammation. They are practically non-toxic. 



THERAPEUTICS AND MATERIA MEDIC A. 151 

Differentiate the conditions in which opium and hyoscine 
should be used to promote sleep. 

Hyoscine is useful as a hypnotic in children, and in general 
in conditions in which opium is contra-indicated. Children 
are particularly susceptible to opium, and an opium habitue 
would require a different hypnotic. 

State when calomel or podophyllum should be given and 
give the reason for the selection. 

Calomel is unirritating, and has also a diuretic effect. 
Podophyllum is more irritating and causes more griping, 
and is to be selected in cases of habitual constipation. 

Name the coal-tar products used to reduce temperature. 

Their name is legion. Those in general use are antipyrin, 
phenacetin, acetanilid. 

Describe the alkaloid, strychnia, and give a test for de= 
termining its presence. 

Strychnia is an alkaloid derived from the seed of strychnos 
nux vomica, a tree of the natural order Loganiacese, growing 
in India and China. Strychnia and its salts dissolve without 
color in concentrated sulphuric acid, but on adding to the 
solution lead peroxide a beautiful blue color results, passing 
into violet, then red, and finally yellow. 

What are the derivatives of cinchona and their doses? 

Cinchona bark contains 21 natural alkaloids, of which 4 
are official, quinine, quinidine, cinchonine and cinchonidine. 
The sulphate of these alkaloids may be administered in the 
following doses : 2 to 20 grains, 1 to 30 grains, 5 to 30 grains, 
1 to 20 grains. 

Describe four diuretics and give the dose of each. 

Potassium citrate occurs in transparent crystals, is odor- 
less, of cooling saline taste and a neutral reaction, dose 5 to 
30 grains. Spartein sulphate, the alkaloid of scoparius, oc- 
curs in white prismatic crystals of slightly saline and bitter 
taste, dose y 2 to 2 grains. Digitalis (elsewhere described), 



152 THERAPEUTICS AND MATERIA MEDIC A. 

dose of the tincture 10 minims. Calomel, the mild chloride 
of mercury, is efficient as a diuretic in y 6 grain doses every 
hour. 

How does a lethal dose of gelsemium affect the system? 

In toxic doses it produces vertigo, diplopia, drooped eye- 
lids, dilated pupils, labored respiration, slow and feeble 
heart, dropped jaw, staggering gait, extreme muscle weak- 
ness, almost complete anesthesia, and death by asphyxia. 

Name three indications for the use of opium. 

To relieve pain, to produce sleep, to check excessive secre- 
tion, as in dysentery. 

How does opium act when used as in the last question? 

The principal action of opium is on the nervous system, 
first affecting the cerebral convolutions, which are briefly 
stimulated and soon depressed; next the perceptive and sen- 
sory centers in the higher brain are blunted and the con- 
ductivity of the afferent nerves is impaired. The hypnotic 
action of opium is believed to be due to the lessened activity 
produced by the drug on the nerve cells and the consequently 
lessened demand for blood. Its constipating • action is pro- 
duced by stimulation of the inhibitory nerves of the intestine 
through the splanchnica. 

What are the therapeutic uses of the preparations of 
bismuth? 

Locally the insoluble bismuth salts are used in acne, rose- 
cea, stomatitis, coryza, gonorrhea and leucorrhea. The sub- 
nitrate is regarded as of great value in diarrhea and dysen- 
tery, in disordered digestion, vomiting, gastralgia and gastric 
ulcer. The bismuth nitrate is soluble and toxic, and is not 
generally used. The subcarbonate and the subgallate are used 
in similar class of cases as the subnitrate. 

How would you distinguish quinine from the other cin= 
chona alkaloids? 

The slight solubility of the sulphate of quinine in water 
distinguishes this alkaloid from other cinchona alkaloids. 



THERAPEUTICS AXD MATERIA MEDIC A. 153 

Give the adult dose of phosphorus, arsenious acid, tinc= 
ture of belladonna and tincture of aconite. 

1-100 grain ; 1-50 grain : 5 to 30 minims ; 1 to 3 minims. 

What condition of the eye contra=indicates the use of 
mydriatics? 

All diseases increasing intra-ocular tension. 

Describe the physiologic action of arsenic and name 
three indications for its use. 

In therapeutic dose, with the exception of a slight increase 
in the pulse, arsenic exerts very little influence on the circu- 
lation. In toxic dose it causes the fall of blood pressure. In 
medicinal dose it is a cerebro-spinal stimulant, but in toxic 
doses it paralyzes the spinal cord, especially the sensory side. 
Small doses increase the appetite and stimulate digestion. 
Toxic doses produce violent gastro-intestinal inflammation. 
In small doses it diminishes and in large doses increases tissue 
waste. In concentrated form it is a powerful irritant and 
escharotic. It is indicated in anemia, malaria and diabetes. 

Describe vasomotor depressants, with an example. 

Vasomotor depressants are drugs which act upon the de- 
pressor nerves of the vasomotor center and cause reflex dila- 
tation of the small vessels. Aconite affords an example. 

Describe and give the indications for the uses of cardiac 
sedatives, with an example. 

Cardiac sedatives are drugs which are used to decrease the 
activity of the circulation. The indications for their use are 
increased arterial excitement, splenic fevers and severe local 
inflammation. Aconite is an example of such a drug. It 
reduces very markedly the rate of the pulse and the arterial 
pressure. 

Describe the physiologic action of antipyrin in medicinal 
doses on the circulation and temperature. 

After the ingestion of a full medicinal dose there is a stim- 
ulant stage, in which the heart's activity is increased; this is 



154 THERAPEUTICS AND MATERIA MEDIC A. 

soon followed by profuse sweating, coolness of the surface, 
slowed pulse, considerable depression, and if fever be present 
by lowered temperature. In health it has very slight anti- 
pyretic effect. It raises the arterial tension and blood pres- 
sure. 

How do digitalis and belladonna act in increasing blood 
pressure? 

Digitalis increases blood pressure by its powerful stimu- 
lating effect on the heart by contraction of the arterioles, 
resulting indirectly from stimulation of the vasomotor center, 
and directly from the action of the drug on the vessel wall. 
The increased blood pressure produced by belladonna is due 
to stimulation of the vasomotor centers and the heart itself. 

Name a vasomotor stimulant, a vasomotor depressant 
and describe the physiologic action of each. 

Belladonna is a vasomotor stimulant; it quickens the pulse 
and raises arterial pressure. The increased blood pressure 
is due to stimulation of the vasomotor center and the heart 
itself. Toxic doses paralyze the heart; large doses stimulate 
the respiratory center; toxic doses paralyze it; large doses 
stimulate the brain and spinal cord and act as a depressant 
to the motor and sensory nerves; it lessens nearly all of the 
secretions except that of the kidney; it dilates the pupil by 
paralyzing the peripheral ends of the oculo-motor nerves 
and by stimulating the ends of the sympathetic. Veratrum 
viride is a vasomotor depressant; it lessens in a marked de- 
gree the force and rate of the cardiac pulsation; the lowered 
arterial tension results from depression of the vasomotor cen- 
ter and of the heart itself; the slowing of the pulse from 
stimulation of the inhibitory nerves of the heart and from 
weakening of the cardiac muscles. Large doses depress the 
respiratory center, the spinal cord and peripheral nerve and 
muscles. 

Give the theory of the alkaline treatment of rheumatism. 

The alkaline treatment of rheumatism by the administra- 
tion of potassium acetate, citrate, etc., was in general use 



THERAPEUTICS AND MATERIA MEDIC A. 155 

before the introduction of the salicylates. Wood states that 
the alkalies do good in rheumatism by lowering arterial ac- 
tion, by favoring oxidation and elimination of partially effete 
products, and by neutralizing excessive acidity. 

What is incompatibility in medicine, and what are the 
different kinds of incompatibles? Give an example of 
each. 

Incompatibility in medicine signifies that a combination is 
not suitable for administration. Incompatibility may be 
chemical, pharmaceutical and therapeutic, according as the 
prescribed combination results in chemical decomposition, 
physical disassociation or antagonistic action. An example 
of chemical incompatibility is seen in the prescribing of qui- 
nine sulphate with potassium acetate, resulting in a volu- 
minous precipitate of quinine acetate. An instance of phar- 
maceutical incompatibility is the addition of an acid to a 
quinine and liquorice mixture, resulting in precipitation of 
the glycyrrhizin, relied on to cover the taste of the quinine by 
the acid. Therapeutic incompatibility rises when two agents 
are mixed together when they oppose each other in their ac- 
tion, for instance belladonna and physostigma. 

Describe the physiologic action of salicylic acid. 

Salicylic acid is a powerful antipyretic and antiseptic. In 
small doses it stimulates the stomach, heart and respiration, 
but moderate quantities derange the stomach, causing nausea 
and vomiting, while large doses depress the heart's action 
and the respiration, lower the arterial tension, relax the ves- 
sels and produce free perspiration. 

Name the therapeutic uses of apomorphia and state how 
codeia differs in its physiologic action from morphia. 

Apomorphia is a valuable emetic and a useful expectorant 
in the dry stage of acute bronchitis, and in chronic bronchitis 
when the expectoration is viscid and scanty. While codeia 
possesses but feeble hypnotic powers, it exerts a sedative influ- 
ence similar to morphine ; it is at times much better borne by 
patients than morphine, but is regarded as less reliable. 



156 THERAPEUTICS AND MATERIA MEDICA. 

Enumerate the symptoms arising from a toxic dose of 
digitalis. 

Digitalis poisoning is characterized by obstinate vomiting, 
diarrhea, headache, severe pain in the back and limbs and a 
very slow, full pulse, which, when the patient sits up, may 
become rapid and feeble. Later, even in recumbency, the 
pulse becomes rapid, thready and irregular, the surface cold, 
the urine suppressed and the mind stuporous. Intelligence, 
however, is not lost until shortly before death. Occasionally 
convulsions develop during the last stage. 

What are the therapeutic uses of tartar emetic? 

It is employed as an emetic, diaphoretic, sedative, expecto- 
rant, cardiac depressant and counter-irritant. 

Describe cantharis and name four official preparations. 

Cantharis is the dried body of the beetle, Cantharis vesica- 
toria, found chiefly in the south of Europe. The active prin- 
ciple is cantharidin. Ceratrum cantharidis, collodium can- 
tharidatum, emplastrum picis can thari datum, tinctura 
cantharidis. 

By what rule would you determine the dose of any medi= 
cine for a child? 

Young's rule will be found the most convenient. Add 12 
to the age and divide by the age, to get the denominator of a 
fraction, the numerator of which is 1 ; thus, for a child 2 years 
old, 2 plus 12 divided by 2 equals 7, and the dose is 1-7 of that 
for an adult. 

Name ten official preparations of mercury. Name four 
alkaloids of opium. 

Hydrargyrum cum creta, massa hydrargyri, unguentum 
hydrargyri, emplastrum hydrargyri, hydrargyri chloridum 
mite, hydrargyrum ammoniatum, unguentum hydrargyri 
ammoniati, hydrargyri oxidum flavum, unguentum hydrar- 
gyri oxidi flavi, hydrargyri oxidum rubrum. The four alka- 
loids of opium are morphine, codeine, thebaine and narcotine. 



THERAPEUTICS AND MATERIA MEDIC A. 157 

Give the source and dose of sparteine, eserine, picrotoxin, 
creosote and pix liquida. 

Sparteine is the alkaloid of scoparius, close of the sulphate 
Y 2 to 3 grains. Eserine is an alkaloid of physostigma, dose 
1-80 to 1-20 grain. Picrotoxin is a neutral principle derived 
irom cocculus indicus, dose 1-100 to 1-20 grain. Creosote is 
a product obtained from distillation of wood -tar, dose 1 to 5 
minims. Pix liquida, tar, is an oleoresin obtained from the 
destructive distillation of certain species of pinus ; the dose is 
5 to 10 grains. 

What are the principal therapeutic uses of the prepara= 
tions of mercury? 

The plaster of mercury is used as an absorbent and counter- 
irritant over chronic inflammatory swelling, glandular en- 
largements, syphilitic nodes, etc. Mercurial ointment and 
the oleate of mercury are used for the same purposes as the 
plaster; they are also extensively employed in the treatment 
of syphilis by inunction. Blue mass is used as a cholagogue, 
laxative and diuretic. Ammoniated mercury is used exter- 
nally as a stimulant or parasiticide. The chloride of mer- 
cury is an antiseptic, anti-parasitic, anti-syphilitic and ab- 
sorbent, and a tonic. The mild chloride, calomel, is used 
internally as an anti-syphilitic, as a laxative, as a gastric 
sedative, a cholagogue and a diuretic, and externally as a 
stimulant and desiccant. Mercury and chalk is used in the 
same class of cases as calomel. The yellow iodide is fre- 
quently used as a substitute for the chloride, as is the red 
iodide. The nitrate is used externally as a powerful caustic. 
The oxide is used externally for its stimulant and alterative 
effect. The yellow sulphate, turpeth mineral, is sometimes 
employed as a stimulating emetic for children, but it is dis- 
tinctly poisonous. 

State the contraindications to the use of quinine. 

It is contra-indicated in acute inflammatory affections of 
the brain, eves and ears. 



158 THERAPEUTICS AND MATERIA MEDIC A. 

In what form would you prescribe eucalyptus and in 
what doses? Whence is eucalyptus obtained? 

Eucalyptus is derived from the leaves of the tree Euca- 
lyptus globulus, a native of Australia. It may be prescribed 
in 10 drops to 1 dram doses of the fluid extract or in 5 to 30 
minim doses of the oil in elastic capsules or emulsion. 

In what strength would you use solutions of nitrate of 
silver, borax, permanganate of potash, bichloride of mer= 
cury and creolin for injection into the bladder? 

Silver nitrate, 1 grain in 4 ounces of water ; borax, 10 grains 
to the ounce; permanganate of potassium, 20 grains to the 
pint; bichloride of mercury, 1 to 3000; creolin, y 2 to 1 per 
cent. 

Name six drugs containing large quantities of tannic 
acid. 

Galla, catechu, hamamelis, kino, granatum, hematoxylon. 

Name four drugs incompatible with iodide of potassium, 
two with atropine and one with antipyrin. 

Potassium iodide decomposes most of the metallic salts. 
The following four drugs are examples of this incompati- 
bility: Sulphate of quinine, sulphate of iron, acetate of lead, 
oxide of zinc. Physostigmine and aconite are incompatible 
with atropine. Tannic acid is incompatible with antipyrin. 

Give the physiologic action of ergot and mention its 
therapeutic uses. 

Ergot is a motor excitant and a vascular contractor. It is 
also hemostatic and anhydrotic, emmenagogue and oxytonic. 
It increases the functional activity of the spinal cord, it stim- 
ulates the vasomotor center, raises the blood pressure, pro- 
duces contraction of unstriped muscle fiber, reduces the cali- 
bre of the arterioles, depresses the motor ganglia of the heart 
and causes a slower and weaker pulsation. 

Ergot is used to promote uterine contractions in labor, in 
amenorrhea due to plethora and in the atonic form of sper- 
matorrhea. It is useful in catarrhal inflammations of the 



THERAPEUTICS AND MATERIA MEDIC A. 159 

mucous membranes generally. It is an excellent remedy in 
chronic diarrhea and dysentery, in hemorrhages of arterial 
type, in headache and migraine of congestive form, in mye- 
litis and tabes and chronic nervous diseases. It is also used 
locally in hemorrhages. 

Name four drugs used in the treatment of bronchorrhea 
and explain their action. 

Eucalyptus for its expectorant effect. Lead acetate for its 
astringent effect to restrict secretions. Quinine and arsenic 
as valuable tonics and restoratives. 

What is the physiologic action of rhubarb in dose of i 
to 5 grains? In dose of 30 to 60 grains? 

In small doses its action is that of a gastric tonic and an 
intestinal astringent. In larger doses its cathartic action 
prevails, producing in 6 to 8 hours copious yellow stools with 
some griping and considerable hepatic stimulation. 

For what purposes is diaphoresis produced? Name 
three diaphoretics. 

Diaphoretics are employed in medicine to fulfil the follow- 
ing indications: (1) to arrest forming diseases of not very 
severe type, as in general cold and suppressed menstruation; 
(2) to favor absorption, as in dropsy; (3) to aid in the sub- 
sidence of diseases which naturally pass off in a sweat, as 
malaria; (4) to eliminate noxious materials from the blood. 
Three excellent diaphoretics are pilocarpus, spirit of nitrous 
ether and Dover's powder. 

What is the source and what are the therapeutic uses of 
picrotoxin? 

Picrotoxin is a poisonous neutral principle obtained from 
the seeds of cocculus indicus, used in the night sweats of 
phthisis and in the form of an ointment as an anti-parasitic. 

Give the chemical name and the dose of (a) Epsom salts, 
(b) Rochelle salts, (c) Glauber's salts. 

(a) Magnesium sulphate, dose 1 dram to 1 ounce; (b) 



160 THERAPEUTICS AND MATERIA MEDIC A. 

potassium and sodium tartrate, dose y 2 to 2 ounces; (c) so- 
dium sulphate, dose 1 dram to y 2 ounce. 

Describe hypodermoclysis and state the circumstances 
under which it is practiced as a therapeutic measure. 

Hypodermoclysis is the introduction into the subcutaneous 
tissue of fluids in large quantity. It is indicated to replace 
the fluid lost through excessive purging or hemorrhage. It 
may also be used to wash from the body certain impurities 
circulating in the blood and lymph ; in other instances it may 
be used to supply the body with liquid when the stomach will 
not permit drinks to be swallowed, as in gastric ulcer or 
abdominal operations. Normal saline solution is used for 
such injections. The sterilized liquid is placed in a proper 
vessel which is absolutely aseptic, and to which air gains ac- 
cess only by means of a glass tube filled with sterilized cotton ; 
from the lower part of the vessel a rubber tube leads, to 
which is attached a canula carefully sterilized. The skin 
over the place where the liquid is to enter is to be rendered 
sterile. The trocar is then inserted into the subcutaneous 
tissue of the abdomen or thigh and the solution allowed to flow 
at the rate of 1 dram to each pound of body weight in 15 
minutes. The pressure is obtained by raising the container a 
few feet. 

Define galactagogue and sialagogue and give an example 
of each. 

A galactagogue is an agent which increases the secretion of 
milk, example pilocarpus. A sialagogue increases the secre- 
tion and flow of saliva and buccal mucus, example mercury. 

What are the therapeutic uses of salicylic acid and with 
what base is it often combined? 

Salicylic acid is used externally as an antiseptic in the 
dressing of wounds. Mixed with collodium it is a valuable 
application to remove corns and callosities. As an ointment 
it is efficient in chronic diseases of the skin. Internally it is 
of great value in the treatment of acute rheumatism and 



THERAPEUTICS AND MATERIA MEDIC A 161 

gastro-intestinal diseases. It is also employed in pleurisy 
with serous effusion and in diabetes. It is generally given in 
the form of soda salicylate. 

By what process and from what source is sugar of milk 
principally obtained? 

It is a peculiar crystalline sugar obtained from the whey 
of cows' milk by evaporation and purified by recrystallization. 

State the source and give the uses of saccharin. 

It is a sweet imide derived from a coal-tar product, toluene. 
It is about 500 times sweeter than sugar; it is used as a sub- 
stitute for sugar in the food of diabetics and subjects of liver 
disease and corpulence. 

Describe the preparation of lime water. Give the offi= 
cial name and the adult dose. 

Liquor calcis may be given to an adult in doses of % to 4 
ounces. It may be prepared by pouring 2 quarts of hot water 
over fresh unslaked lime the size of a walnut; stir till slaked, 
let it stand until clear and bottle. 

Give the source, the physiologic action and the thera- 
peutic uses of oleum ricini. 

Castor oil is a fixed oil expressed from the seeds of ricinus 
communis. It acts as a mild, but rather slow purgative, pro- 
ducing without irritation copious semi-liquid stools. It does 
not increase the flow of bile nor to a great extent the secre- 
tions of the intestinal canal, but excites catharsis by stimu- 
lating the muscular coat of the bowel. It is useful in acute 
inflammatory affection of the bowel and as a laxative in preg- 
nancy, anal fissure and painful hemorrhoids. 

What is the source of duboisine and what are its physio= 
logic effects? 

Duboisine is an alkaloid obtained from the duboisia myo- 

poroides, a native of Australia. When given internally in 

large dose it acts as a powerful sedative and hypnotic. Toxic 

doses produce vertigo, mydriasis, dryness of the throat, quick- 

11 



162 THERAPEUTICS AND MATERIA MEDIC A. 

ening of the pulse and unsteady gait. When instilled into 
the eye it dilates the pupil. 

What are the medicinal uses of potassium chlorate? 

It is an excellent local application in inflammatory condi- 
tions of the mouth and throat, being valuable in the various 
forms of stomatitis, in acute pharyngitis, in diphtheria and 
scarlet fever. 

How should poisoning by coal gas be treated? 

Antidotes, chlorine water as a spray, inhaled. Antago- 
nists, oxygen by inhalation 4 or 5 quarts. Ammonia vapor 
inhaled. Galvanism, by interrupted current to extremities. 
Artificial respiration, to be maintained steadily for hours. 
Rhythmic traction of the tongue. Fresh air in plenty; open 
all doors and windows. Coffee, black, a pint as enema. 
Venesection may be of service. Douche, alternately cold and 
warm, to head and chest. Horizontal position, clothing re- 
moved. Alcohol moderately by mouth or rectum. Catheter 
may be required in prolonged cases. Subsequently a warm 
bed, heat applied to the body and limbs, open windows, perfect 
quiet, Condy's fluid about the room, stimulants sparingly, 
cold acid drinks freely. 

Write a prescription for a cough mixture containing 
muriate of ammonia and an opiate, giving adult dose. 

January 1, 1903. For Joseph Wilson 

R . Aramonii chloridi 3 v 

Tr. opii camph •' f % v 

Syr. pruni virg f,§ iv 

M. S. — f^i every four hours. 

Joseph Jones, M. D. 

What are the therapeutic uses of podophyllin? 

It is an excellent laxative in constipation associated with 
hepatic congestion. It tends to produce griping, and is usu- 
ally given with small doses of belladonna or hyoscyamus. 

What is the dose of Fowler's solution and what precau= 
tions should be observed in its administration? 

The dose is 1 to 5 minims. Potter advises that full doses 



THERAPEUTICS AND MATERIA MEDIC A. 163 

of the solution should be taken at first, and always immedi- 
ately after food; the dose should then be gradually reduced. 
Susceptible persons often tolerate it better if a few drops of 
laudanum are administered with each dose. Swelling beneath 
the eyes is an indication of the physiologic limit for the em- 
ployment of the drug. 

From what part of the colchicum plant is the active 
principle obtained? 

From the corm and seed. 

What injurious effect is liable to follow the prolonged 
internal use of the preparations of silver? 

Argyria. The first sign of this condition is a slate-colored 
line along the margin of the gum with some inflammatory 
swelling. Subsequently grayish patches appear on various 
parts of the skin and mucous membrane and gradually extend 
over the whole body. As a rule, argyria does not produce 
serious effects on the health of the subject. The pigmenta- 
tion is due to a deposit of silver in the connective tissues. In 
the skin it is found in the corium. The discoloration is per- 
manent. 

Name a vesicant derived from (a) the animal kingdom, 
(b) the vegetable kingdom, (c) the mineral kingdom. 

(a) Cantharides, (b) mustard, (c) iodine. 

Write a prescription for diarrhea containing an alkali 
and an astringent suitable for a child of ten years. 

January 1, 1903. Walter. 

R . Sodii bicarbonatis 3 " 

Bismuthis subcarbonatis 3 ii 

Tragacantb.se 3 i 

Spts. chloroformi f % i 

Aquae cinnamomi f J iv 

M. S. — Teaspoonful every four hours. 

Joseph Jones, M. D. 

What is the vulgar name for veratrum viride? What is 
its active principle and the dose of the principle? 

American hellebore. It contains several active principles, 



164 THERAPEUTICS AND MATERIA MEDIC A. 

of which the most important is veratrine. The dose of the 
tincture is 3 to 6 drops. 

For what medicinal purposes is senna used? 

It is used as a laxative in habitual constipation, and in 
larger doses as a cathartic. 

Write a prescription for an ointment containing a rube= 
facient and at least one other constituent. 

January 1, 1903. . , For John Smith. 

R . Unguenti hydrargyri nitratis 5 iv 

Sulpburis 5J ii 

Creosoti gtt. x 

Adipis f Sji 

Fr. unguentum f 3 i 

S. — Hub in well. James Jones, M. D. 

What is the usual physiologic action of an astringent 
administered internally? 

Astringents are agents which produce contraction of muscle 
fiber and condensation of other tissues. They lessen secre- 
tions from mucous membranes. 

What are the medical uses of ammonia? 

Ammonia is employed in medicine when a quickly-acting 
heart and respiratory stimulant is required. It is also used 
as an antacid and a counter-irritant. 

What is the common name of serpentaria? 

Virginia snake root. 

What are the therapeutic uses of sodium chloride? 

A bath may be made more stimulating for debilitated pa- 
tients by the addition of a few ounces of salt to the water. 
An enema containing 1 or 2 tablespoonfuls of salt to the pint 
of water is sometimes used effectively against thread-worms. 
The subcutaneous or intravenous injection of a .6 per cent, 
solution of sodium chloride has proved of marked benefit in 
cholera, uremia and acute anemia from hemorrhages. 

What are the therapeutic uses of lime (calcium)? 

Lime in its unslaked form has a great affinity for water, 



THERAPEUTICS AND MATERIA MEDIC A. 165 

and readily combines with- sulphur, thereby decomposing and 
destroying organic matter. Upon the skin its action is irri- 
tant and superficially caustic, but more severe on the mucous 
membrane, and if inhaled or swallowed it may produce dan- 
gerous inflammation, followed by ulceration. In weak solu- 
tion it has a sedative and an astringent effect, both locally 
and internally, and acts as an absorbent and antacid. 

For what pathologic conditions may capsicum be used? 

It is an excellent stomachic tonic in atonic dyspepsia and 
in that of chronic alcoholism with tremor and insomnia. In 
acute dipsomania large doses are effective in producing sleep 
and promoting appetite. Locally, capsicum plaster is a mild 
counter-irritant. 

What is the ordinary relative strength of a tincture to 
a fluid extract of the same drug? 

In strength the fluid extracts, a cubic centimeter in each 
case, represent the medicinal powers of 1 dram of the drug. 
Tinctures are very much weaker, 5 centimeters of the tincture 
representing various quantities in drams of the drug, from 
5 to 50. 

Name three agents which are used to promote menstru= 
ation. 

Potassium permanganate, purgatives, as castor oil, and 
ergot. 

How do the preparations of gentian affect the human 
system and in what conditions are they indicated? 

Gentian is used exclusively as a bitter tonic. In atonic 
dyspepsia it increases the appetite and stimulates digestion. 

The dose of a medicine given by the mouth being i grain, 
what would be the equivalent dose for hypodermic use 
and what for administration by the rectum? 

For hypodermic injection the dose should be % or % of 
that used by the mouth. By the rectum 5-4 of the same. 



166 THERAPEUTICS AND MATERIA MEDIC A. 

How should a case of poisoning with chloral hydrate be 
treated? 

The patient should be aroused by friction, douches, etc., 
but must not be made to walk, as in opium poisoning, on ac- 
count of heart failure. Cardiac and respiratory stimulants 
should be given freely, as ammonia, atropine and strychnine. 
Artificial respiration should be resorted to early, before the 
development of asphyxia. 

In what conditions may cathartics be useful in the treat* 
ment of diarrhea or dysentery? 

Cathartics are useful in the treatment of diarrhea and dys- 
entery, especially early in the course of this condition, in the 
case of diarrhea for the purpose of removing offending mate- 
rial, as indigestible food, discharges, bacteria, etc. 

Define a laxative, a saline purgative, a drastic purgative, 
a hydragogue purgative and a cholagogue purgative, with 
an example of each. 

Laxatives are drugs which excite moderate peristalsis and 
produce soft stools without irritation, as sulphur. Saline 
purgatives include the neutral salts of metals, of the alkalies 
or alkaline earths; they stimulate the intestinal glands to 
increased secretions and produce a copious evacuation, as 
Epsom salts. A drastic purgative produces violent peri- 
stalsis and watery stools, with much griping pain and tenes- 
mus ; in large doses irritant poisoning results, as jalap. Hy- 
dragogue purgatives are those which remove a large quantity 
of water from the vessels, as elaterium. Cholagogue purga- 
tives stimulate the discharge of bile and produce free purga- 
tion, as podophyllin. 

For what pathological conditions may buchu be used 
with advantage? 

It is employed almost exclusively as a stimulating diuretic 
in subacute and chronic inflammations of the genito-urinary 
tract, as in pyelitis, cystitis and urethritis. 



THERAPEUTICS AND MATERIA MEDIC A. 167 

Would you administer charcoal internally, and if so in 
what dose and for what purpose? 

It may be given with advantage in chronic gastric catarrh, 
cancer, intestinal dyspepsia and diarrhea when flatulence is a 
prominent symptom. Dose is 10 to 20 grains. 

What are the physiologic effects of gelsemium and what 
is the dose of the tincture? 

Medicinal doses do not affect the circulation. Toxic doses 
depress the heart. It is a marked depressant to the spinal 
cord, and in toxic doses produces paralysis. The drug kills 
by paralyzing the respiratory center. Locally the drug 
causes dilatation of the pupil, probably from paralysis of the 
oculo-motor nerve. Dose of the tincture 10 to 20 minims. 

Describe the therapeutic uses of jalap and state how it 
differs in effect from aloes. 

In moderate dose jalap acts as a hydragogue cathartic, pro- 
ducing copious watery discharges. It is best given in the 
form of compound jalap powder in conditions of general 
dropsy, and should never be employed in simple constipation. 
Aloes is a cholagogue cathartic, stimulating the discharge of 
bile. 

Name two remedies which are commonly used to pro= 
mote intestinal peristalsis. 

Belladonna and nux vomica. 

Define an antiseptic agent and mention three which are 
commonly used. 

An antiseptic agent is one possessing the power of destroy- 
ing bacteria. The three commonly used are bichloride of 
mercury, permanganate of potash and carbolic acid. 

What are the therapeutic uses of guaiac? 

Used locally and internally in acute bronchitis; often pre- 
scribed in chronic rheumatism, gout, sciatica and lumbago. 

Name the official bromides. 

The bromides of potassium, sodium, lithium, ammonium, 
strontium and zinc. 



168 THERAPEUTICS AND MATERIA MEDIC A. 

Describe the therapeutic uses of ox=gall. 

It is a tonic, antiseptic and purgative, stimulating the ab- 
sorption powers of the mucous membrane. It is frequently 
used as a laxative in constipation. 

Where does buckthorn grow? Give the official prepa= 
ration and dose. 

In Europe. Fluid extract of frangula. Dose % to 2 
drachms. 

What are the therapeutic uses of gelsemium? 

It is indicated in all conditions of exalted nerve function, 
and contra-indicated whenever the heart is weak. It is espe- 
cially useful in cerebro-spinal meningitis, mania, persistent 
insomnia, neuralgia, dysmenorrhea, incontinence of urine, 
irritation of the bladder, spasmodic coughs and remittent or 
typho-malarial fevers. 

What is the purgative dose of acetate of potassium? 

Two to four drachms. 

What is the common name and therapeutic use of 
plumbi acetatis? 

Sugar of lead. It is a component of the mixture of lead 
water and laudanum, which is employed in bruises and in- 
flammatory swellings where the skin is not broken. It is 
used in solution as a lotion in skin diseases and pruritus, and 
is employed as an astringent in diarrhea. 

How do official waters, e. g. aqua camphorae, differ from 
solutions, e. g. liquor calcis? 

Waters are aqueous solutions of volatile substances ; liquors 
compose all aqueous solutions of non-volatile substances. 

How do potassium acetate and potassium bitartrate 
compare as diuretics and purgatives? 

The acetate is the most certain diuretic; the bitartrate is 
the most active cathartic. 



THERAPEUTICS AND MATERIA MEDIC A. 169 

Give the common name and the official preparations of 
prunus Virginiana. 

Wild cherry. The official preparations are the fluid ex- 
tract, infusion and syrup. 

On what chemical change in the intestinal tract does 
the purgative action of castor oil depend? 

The oil is decomposed by the pancreatic juice setting free 
ricinoteric acid, which produces purgation by a mildly irritant 
action on the bowels, stimulating the glands and muscular 
coat, but not the liver. 

What are the therapeutic uses of acetic acid? 

Used internally as a mild refrigerant and antiscorbutic, 
and as an antidote in poisoning by alkalies, such as ammonia. 
Locally it is used to check hemorrhages and as an eschar otic. 

What is the proportion of mercury in blue pill? What 
is the dose of blue pill? 

It contains 33 per cent, of mercury. Dose 1 to 20 grains. 

What effect has benzoin on the urine? Name the pre= 
parations of benzoin. 

It renders the urine acid and increases its quantity. The 
preparations of benzoin are adeps benzoin, tinctura benzoini, 
tinct. benzoini composita, acidum benzoicum, ammonii ben- 
zoas, lithii benzoas, iodi benzoas. 

What are the alkaloids of pilocarpus and how do they 
compare in physiologic effect? 

The alkalies of pilocarpus are pilocarpine, jaborine, antag- 
onistic to pilocarpine in action; pilocarpidine. analogous to 
pilocarpine, and jaboridine, which is analogous to jaborine. 

What is the source of camphor and what is the dose of 
spiritus camphorae? 

Camphor is a stearopten obtained from the Connamonium 
camphors, a tree of the natural order Laurinece (indigenous 
to China and Japan), purified by sublimation. Dose of the 
spirit 5 to 20 minims. 



170 THERAPEUTICS AND MATERIA MEDIC A. 

Give the common name and the therapeutic uses of 
potassium bitartrate. 

Cream of tartar. It is an agreeable laxative, and also is 
used as a diuretic in infusion of juniper in general cardiac 
dropsy. 

How should ophthalmia neonatorum be prevented and 
how treated? 

Prophylactic treatment. As soon as head is born warm 
water is dropped into the eyes; when delivery is completed 
warm water is again dropped into the eyes, followed by 1 or 2 
drops of a 10 grain argentic nitrate solution. Curative treat- 
ment: The eyes should be cleansed every hour, alternating 
with a concentrated boric acid solution and a 1-8000 bichlo- 
ride of mercury solution. Morning and evening a few drops 
of nitrate of silver solution are dropped in each eye. If only 
one eye is afflicted bandage the other carefully to protect it. 

Give the source and preparations of gum arabic. 

Acacia, gum arabic, is a gummy exudation of Acacia Sen- 
egal, a small tree native to Africa. Its preparations are the 
syrups and mucilage. It enters also into the composition of 
official troches, etc. 

Mention the therapeutic uses of nitric acid. 

It is locally a powerful escharotic, and internally in dilute 
form in bilious affections. It lessens phosphatic deposits and 
acts as an astringent to the system, diminishing the profuse 
expectoration in bronchorrhea and phthisis. 

Give the physiologic action and the therapeutic uses of 
sarsaparilla. 

It is doubtful if it possesses any physiologic action. Some, 
however, claim it to be diuretic, diaphoretic, tonic and alter- 
ative. Its chief value is as an excipient for administering 
potassium iodide and mercuric chloride in syphilis. 

Name three drugs which are administered internally to 
arrest bleeding. 

Ergot, gallic acid and hematoxylon. 



THERAPEUTICS AND MATERIA MEDIC A. 171 

What are the therapeutic uses of magnesia? 

Magnesia is the oxide of magnesium. It is used as an ant- 
acid and laxative in acidity, sick headache, colic, etc., and as 
an antidote in poisoning by acids, arsenic, phosphorus and 
the mercuric and copper salts. 

For what is hydrochloric acid used in medical practice? 

"Well diluted it is useful in fevers, atonic dyspepsia, acidity 
of the stomach, and locally in ulceration of the throat. It is 
the weakest of the mineral acids. 

Mention the medical uses of the oil of turpentine. 

The oil of turpentine is employed externally as a rubefa- 
cient and counter-irritant in many conditions causing pain 
and inflammation. The liniment is in constant use for sprain, 
neuralgia and other slight local affections. Internally it is 
best employed in ulceration and hemorrhage of the intestines, 
and in passive hemorrhage from other organs. It is also used 
as an anthelmintic against tape- worm, and is of value in flatu- 
lent colic. It is employed in chronic bronchitis and chronic 
inflammations of the mucous membranes generally. 

For what are the preparations of juniper used in medi* 
cines? 

Juniper is a stomachic tonic, diaphoretic, diuretic and 
aphrodisiac. The oil acts therapeutically like the oil of tur- 
pentine, and may be used in chronic cystitis, etc., but is 
contra-indicated where acute inflammations of the kidney 
exist. 

How should a case of poisoning with atropine be treated? 

Tannic acid should be given freely and the stomach emptied 
by an emetic or the stomach-pump. Collapse must be met by 
the use of heart stimulants, such as ammonia, alcohol and 
nitro-glycerin. 

What is the vulgar name of physostigma? 

Calabar bean. 



172 THERAPEUTICS AND MATERIA ME DIG A. 



What are the therapeutic uses of the preparations of 



zinc 



9 



The acetate is used as an astringent application in conjunc- 
tivitis and subacute gonorrhea. The precipitated zinc car- 
bonate is used as a sedative astringent in acute inflammatory 
affections of the skin, such as erythema and eczema. The 
chloride is used as an astringent antiseptic and caustic. It 
is also used in chronic inflammation of the mucous mem- 
branes. The oxide is employed in the form of an ointment 
or poAvder externally as a mild astringent and sedative in 
burns, acute ulcers, etc. Internally it is of doubtful value 
as an anti-spasmodic and anti-hydrotic. The phosphide of 
zinc is employed in the same class of cases in which phos- 
phorus is indicated. The sulphate of zinc is employed locally 
as an astringent, and internally is used in chronic dysentery 
and diarrhea, as well as an emetic in large doses in cases of 
narcotic poison. 

Name three official preparations of camphor. 
Aqua camphor w, linimentum camphor <z and spiritus cam- 
phorce. 

Write a prescription containing some preparation of 
iron in a delectable form. 
January 1, 1903. For Wm. Jones. 

R . Tincturae ferri chloridi • • • • f 3 ii 

Acidi phosphorici diluti f % iii 

Spiritus limonis f," i 

Syrupi • • f 3 iiss 

Aquam ad f J vi 

M. S. — Tablespoonful after meals. 

John Smith. M. D. 

What preparations of copper are used in medicine and 
for what purposes? 

The only official salt of copper is the sulphate; it is useful 
in phosphorus poisoning both as an emetic and a chemical 
antidote. The application of the solid crystal is often useful 
for its astringent and stimulating qualities. It is also useful 
in gonorrhea in the subacute stage. Internally it is some- 
times employed in chronic diarrhea. 



THERAPEUTICS AND MATERIA MEDIC A. 173 

What are the therapeutic uses and the preparations of 
borax? 

Borax is sodium borate, which is a powerful antiseptic and 
disinfectant. It has been used internally in amenorrhea, 
dysmenorrhea and puerperal convulsions and epilepsy. In 
the form of a wash it is of value as an anti-pruritic. Boric 
acid is prepared largely from borax by the action of sulphuric 
acid. It is an efficient antiseptic, disinfectant and deodorant. 

With what remedies should spasmodic croup be treated? 
Name three suitable ones. 

With emetics, as ipecac, and with anti-spasmodics, such as 
the bromides. Lobelia is a useful remedy. 

Describe the medicinal uses of hydrocyanic acid. 

Hydrocyanic acid is used solely to allay irritation of the 
peripheral nerves. Thus it is employed internally for the 
cough of phthisis and chronic bronchitis, for gastralgia in 
obstinate vomiting, and externally to subdue the itching in 
pruritis, eczema and urticaria. 

Mention the conditions which affect the dosage of medi= 
cines. 

The age of the patient, the personal idiosyncrasy, the con- 
dition of the heart, kidneys and nervous and respiratory 
system. 

What class of acids would you use to acidify alkaline 
urine? 

Benzoic acid and its derivatives, as benzoate of sodium and 
ammonium. 

What is the dose of phenacetin as an antipyretic? 

Dose 8 to 10 grains every 4 to 6 hours. 

What is the composition of the so=cal!ed green soap? 

Green soap is prepared from potassa and linseed oil. 

Where does arnica grow most abundantly? What part 
of the plant is used in medicine? 

In the mountains of .northern Europe and Siberia. Both 
the flowers and the roots are official. 



174 THERAPEUTICS AND MATERIA MEDIC A. 

What is glycerin and what are its therapeutic uses? 

Glycerin is obtained by the decomposition of vegetable or 
animal fats or fixed oils. It is a trihydric alcohol, existing 
in fats and fixed oils in combination with the fatty acids. 
Externally it is nsed in various forms as an emollient. In 
the various acute inflammations of the fauces, it makes an 
excellent vehicle for carrying other drugs. Being hygro- 
scopic, it not only depletes the turgid vessels, but it spreads 
the medicant over the entire surface. It is especially useful 
in tampons in such conditions as uterine congestion. It may 
be employed in suppository in obstinate constipation. It is 
sometimes used as a substitute for sugar in diabetes. 

What is the dose of sulphate of atropine? 

1-60 to 1-150 grain. 

How many grains of the hydrochlorate of cocaine are 
contained in one ounce of a ten per cent, solution? 

Forty-eight grains. 

What is the dose of the fluid extract of senna? 

Two to four drams. 

By what common name is sulphate of sodium known? 

Glauber's salt. 

What injury may result from large doses or long con= 
tinued use of potassium chlorate? 

The chlorate is distinctly irritant to the kidneys. An in- 
flammation of these organs may follow its use. 

Give the habitat of squills and state which of its prepa= 
rations are used in medicine. 

It is native to southern Europe. The preparations are 
vinegar of squills, fluid extract, syrup, compound syrup and 
tincture. 

Describe the therapeutic uses of olive oil and state where 
it is principally produced. 

It is produced principally in southern Europe, California 



THERAPEUTICS AND MATERIA MEDIC A. 175 

and Australia. Externally used it is a good protective from 
the air, and if rubbed into the skin is absorbed by the lym- 
phatics and is directly nutritive. Internally it is a food and 
a mild laxative, and in quantity protects the mucous mem- 
branes against the action of poisonous substances. 

How should phosphorus poisoning be treated? 

Immediate full dose of sulphate of copper, which is an 
emetic as well as a chemical antidote. Potassium perman- 
ganate and French oil of turpentine are also of value. 

What is the dose of oleum erigerontis? 

The oil of fleabane is not official. It has the same action as 
oil of turpentine in a milder way. Dose 10 to 30 minims. 

Write the following prescription in the metric system: 

& . Amraonii brornidi 2 drams 

Sp. ammonia? aromat 1 dram 

Aquae 4 ounces 

Misce. 

R . Ammonii bromidi grams 7. 78 

Sp. ammonia? aromat grams 3. 89 

Aqua? cubic c. c. 118. 

Misce. 

What is the dose of oleum sabinae? 

One to five drops. 

What medicine would you give to promote bone growth? 

Some of the preparations of lime, as lime water, or the 
carbonate or phosphate. 

What is the alkaloid of pomegranate and for what is it 
used? 

Pellatierine; it is a teniafuge. 

By what other names is saltpetre known? 

Potassium nitrate and nitre. 

In what dose may sulphonal be administered to an adult 
to produce a soporific effect? 

It may be given in 10 to 20 grain doses in hot milk about 2 
hours before retiring. 



176 THERAPEUTICS AND MATERIA MEDIC A. 

To what chemical change does sulphur ointment owe its 
efficiency as a parasiticide? 

Sulphur ointment contains an alkaline ingredient and de- 
velops sulphides which are powerful anti-parasitics. 

Define and describe an alkaloid. 

Alkaloids are organic basic substances existing in many 
plants, usually in combination with organic acids. They 
readily combine with acids to form crystalline salts which, 
are soluble in water, the alkaloids themselves being almost 
insoluble in water, although dissolving in alcohol; they are 
odorless, of bitter taste, and generally possess physiologic 
actions. Their Latin names terminate in -ina ; their English 
names in -in. Chemically the alkaloids may be regarded as 
derivatives of ammonia, in which one or more atoms of H are 
replaced by various radicles. 

What are the uses of lactic acid in medical practice and 
what pathologic conditions may its administration pro= 
duce? 

It is employed as a mild caustic, a digestant and intestinal 
antiseptic. It is a valuable local remedy in laryngeal tuber- 
culosis, and internally in cholera, typhoid fever, simple diar- 
rhea and the diarrhea of infants. It is supposed to cause 
acute rheumatism when in excess and free in the blood. 

Write the following prescription in the metric system: 

R . Morphinse sulphatis grains 6 

Sodii boratis drams 4 

Aquse camphorse fl. ounces 6 

H . Morphinse sulphatis 387 milligrams 

Sodii boratis 15.5 grams 

Aquse camphorse 1 77. cubic c. c. 

What is the effect of full doses of opium on respiration 
and to what extent may this effect be safely carried in 
treatment? 

In full dose there is irregular and slow respiration. It 
should not be used when there is profuse expectoration, as 
the lowering of excitability of the respiratory center which it 



THERAPEUTICS AND MATERIA MEDIC A. 177 

produces would be dangerous in such a case. Morphine is 
combined with atropine to overcome the effect of the former 
on the circulation. It should be avoided in all organic dis- 
eases of the lungs associated with weak respiration. 

What are the principal alkaloids obtained from cinchona 
bark and used in medicine? 

Quinine, quinidine, cinchonine and cinchonidine. 

Where is colocynth obtained and for what is it used? 

Colocynth is the fruit of citrullus colocynthis deprived 
of its rind. The plant is a native of Spain and Asiatic 
Turkey. It is classed among the tonic, astringent and resin- 
bearing purgatives. In moderate doses it increases peristal- 
sis and the intestinal glandular secretion ; watery evacuations 
with griping pain. 

What are the three principal vegetable emmenagogues? 

Ergot, savine and tansy. 

What is the comparative action of strychnine and alcohol 
on the arterioles? 

Strychnine raises the arterial pressure by stimulating the 
vasomotor center in the medulla. Alcohol inhibits the vaso- 
motor system, causing dilatation of all the vessels of the body, 
especially those of the periphery. The blood pressure is 
raised, however, owing to the great increase of cardiac action, 
which overcomes the results of the arteriole dilatation. 

How may carbolic acid poisoning be produced and how 
treated? 

Carbolic acid poisoning may be induced by the local use, 
especially of weak solutions, of the acid, as well as by the 
internal ingestion of carbolic acid or its derivatives. The 
treatment of the poisoning consists of the administration of 
the antidote, which is a soluble sulphate, as sulphate of mag- 
nesium ; this unites with the acid, forming an insoluble sulpho- 
carbolate. Evacuation of the stomach, the application of 
external heat and stimulants and the use of mucilaginous 
drinks are indicated. 
V2 



178 THERAPEUTICS AND MATERIA MEDIC A. 

Would you write for potassium chlorate and tannin in 
the same prescription? Give reason for your answer. 

No. Tannin precipitates potassium chlorate. 
Mention the therapeutic uses of gamboge. 

Gamboge is an irritant purgative, decidedly diaphoretic; 
its catharsis is accompanied by vomiting and colic. It has 
no cholagogue action. Its use, for the most part, is limited 
to the compound cathartic pill, of which it is a constituent. 

Where is kousso obtained, what preparation is used and 
for what purpose? 

Kousso is a native of Abyssinia ; it is used in the form of the 
fluid extract as an anthelmintic against tape-worm. 

What remedies should be used for hemorrhages from 
mucous surfaces? 

The astringents and vaso-contractors ; the extract of super- 
renal gland is probably of greatest value; ergot, gallic acid 
and opium are employed internally. 

On what theory can the use of salol in diarrheal diseases 
be advocated? 

In the intestine it is separated into carbolic and salicylic 
acids and acts as an antiseptic. It is free from irritating 
properties. 

For what is copaiba used in medical practice? 

Copaiba is used in subacute or chronic inflammations of the 
genito-urinary tract. 

Name a drug commonly used which affects the color of 
the stools without altering the constituency, and explain 
the cause. 

The organic salts of iron blacken the feces by conversion 
into a sulphide. 



OBSTETRICS AND GYNECOLOGY. 



Describe the female reproductive organs. 

The ovaries are two small almond-shaped organs situated 
one on either side of the uterus (described below) and at- 
tached to the posterior surface of the broad ligaments. Each 
is 4 cm. long, 2 cm. broad and l-y 2 cm. thick, and weighs 6.4 
gm. (100 grains). It consists of the oophoron or egg-bearing 
portion and the paroophoron or fibrous portion. 

The oviducts or Fallopian tubes are the trumpet-shaped 
structures attached to the uterine cornua. Each tube is about 
11% cm. long, and surrounds the corresponding ovary. The 
outer end is the fimbriated extremity. The tube is lined with 
ciliated epithelium, which facilitates the passage of the ovum 
to the uterus. 

The vagina or organ of copulation is the passage from the 
vestibule to the cervix. It lies at an angle of 60° to the hori- 
zon. It has two walls, anterior and posterior. Its mucous 
membrane lies in folds or ruga?. 

The hymen is the fold of vaginal mucous membrane guard- 
ing the lower orifice of the vagina. 

The vulva or external genitals includes the labia major a, 
labia minora, clitoris, vestibule and mons veneris. The labia 
major a are the fleshy folds on either side of the vestibule; 
the labia minora or nymphs are the two small mucous folds 
situated within the greater lips; they unite above to form 
the prepuce of the clitoris. The latter is the analogue of the 
penis. The vestibule is the triangular space bounded above 
by the clitoris, laterally by the labia minora, and below by the 
orifice of the vagina. The mons veneris is the fleshy eminence 
above the symphysis pubis. 

( 179 ) 



180 OBSTETRICS AND GYNECOLOGY. 

Give a description of the physiology of menstruation. 

Menstruation is a periodic series of phenomena occurring 
normally every 28 days in the non-pregnant female from 
puberty to the menopause, ' consisting of certain symptoms 
(menstrual molimina) and a characteristic sero-sanguinolent 
discharge derived from the congested mucosas of the tubes 
and uterus. The process consists in a growth of the stroma 
of the uterine mucosa and a breaking down of the congested 
vessels, with consequent formation of lacunas, which rupture. 

What is the duration of menstruation and what are the 
resulting changes in the uterine mucous membrane? 

Menstruation normally lasts 3 or 4 days. It is accom- 
panied by a growth in the stroma of the uterine mucosa, or 
congestion of the vessels which rupture, and a subsequent 
degeneration of the superficial layers of the mucosa. 

What is vicarious menstruation? 

A periodic discharge of blood or other fluid from the nose, 
breast, stomach, or other organ during a period of suppressed 
menstruation. 

What are the abnormalities of menstruation and give 
their etiology and treatment. 

The abnormalities of menstruation are: Amenorrhea, or 
absence of the menstrual fluid ; scanty menstruation, or insuffi- 
cient flow; menorrhagia, or excessive flow at the menstrual 
periods ; metrorrhagia, or a flow between the periods ; and 
dysmenorrhea, or painful menstruation. Amenorrhea results 
from anemia, chlorosis, phthisis, nervous and mental dis- 
eases, change of climate, and uterine and ovarian defects of 
development. It is treated by diet, exercise, iron, tonics, 
arsenic, and the so-called emmenagogues. Menorrhagia and 
metrorrhagia result from endometritis, tumors, salpingitis 
and other causes of pelvic congestion, including subinvolu- 
tion after labor. They may be treated by astringents inter- 
nally, as hydrastis, ergot, oil of erigeron, thyroid extract, and 
mammary extract, or by local treatment, including curettage. 



OBSTETRICS AND GYNECOLOGY. 181 

Dysmenorrhea requires dilatation and curettement and re- 
placement of displaced organs. 

What conditions have a bearing on the time of life in 
the female when menstruation first occurs? 

Race, social development, climatic influences and predis- 
position. The average age of puberty in this country is about 
the fourteenth year. 

What is the placenta? From what is it formed, what 
is its structure and what are its functions? 

The placenta is the essential nutritive and respiratory organ 
of the fetus. It is formed from the chorion frondosum and 
the decidua serotina, and assumes its functions by the end of 
the third month. 

Describe the development of the placenta. 

During the rapid development of the chorion frondosum, 
or hairy chorion, a corresponding change takes place in the 
decidua serotina; its tissues hypertrophy and become thick, 
spongy and very vascular. The chorionic villi sink deeply 
into this pulpy mass and become intimately connected with it, 
permitting of osmosis or interchange of the maternal and 
embryonic blood. By the third month these structures have 
developed into the fully formed placenta. 

What are the functions of the placenta? 

1. The supplying of nourishment from the mother to the 
fetus. 2. The oxygenation of the impure fetal blood. 3. 
The excretion of the effete products from the fetus. 

Describe the human uterus and give its anatomic 
relations. 

The uterus is a hollow muscular organ situated in the cen- 
ter of the pelvis and embraced between the folds of the broad 
ligaments. It is 7% cm. long, 4 cm. broad, and 2% cm. thick ; 
it weighs 31 grams (7 drams). The upper portion above the 
point of entrance of the Fallopian tubes is the fundus, the 
portion between the tubes and the internal os is the tody 



182 OBSTETRICS AND GYNECOLOGY. 

proper, and that between the internal and external os is the 
cervix. The flattened anterior surface is in close juxtaposi- 
tion with the bladder ; the posterior surface is separated from 
the rectum by Douglas' pouch or cul-de-sac. The cavity of 
the uterus measures 6y 2 cm. (2y 2 in.). 

How is the uterus supplied with nerves? 

The uterus is supplied by filaments from the hypogastric 
and ovarian plexuses of the sympathetic nervous system. 

Describe the normal non=gravid uterus, giving its func= 
tions and relation to the other organs of generation. 

The uterus has already been described. It lies above the 
vagina, its axis being at right angles to the axis of the vagina. 
The tubes are continuous with the cornua, and extend one to 
either side of the fundus. The ovaries are on either side of 
the uterus below the tubes. 

Describe the semen. 

The semen is a thick, viscid, yellowish or opalescent fluid, 
with a faint characteristic lime-like odor, secreted by the tes- 
ticles and prostate gland. Its most important constituents 
are the spermatozoids. 

Define insemination and state the conditions necessary 
to its accomplishment. 

Insemination is the deposit of the semen within the vagina 
during copulation. It is not necessarily followed by impreg- 
nation. 

What are spermatozoa? Where are they found? De= 
scribe their appearance and function. 

The spermatozoa are microscopic, tadpole-like bodies pres- 
ent in immense numbers in the semen. They are about 1-500 
of an inch in length, and are derived from the sperm-cells of 
the seminal tubules of the testicles. They have flat, oval 
heads, small bodies, and immensely elongated flagella or tails, 
which are in constant motion. Their function is fertilization 
of the ovum. 



OBSTETRICS AND GYNECOLOGY. 183 

Give the definition, physiology and frequency of ovu!a= 
tion and state whether ovulation and menstruation are 
synchronous. 

Ovulation is the formation, development and discharge of 
a mature ovum from the ovary. It occurs once or twice in 
a month, and is not necessarily synchronous with menstru- 
ation. 

What is the mechanism of the escape of the ovule and 
its transmission to the tubes and uterus? 

Upon the establishment of puberty certain Graafian folli- 
cles assume extraordinary growth, and rapidly approach the 
ovarian surface. Owing to the increased intrafollicular pres- 
sure the capsule yields and the contents — an ovum and the 
liquor folliculi — escape. The ovum is received into the Fal- 
lopian tube either by direct introduction at the time of rupture 
or by suction, and is then carried into the uterine cavity by 
the action of the ciliated epithelium of the tube. 

Define fecundation and describe its physiology. 

Fecundation is the fertilization of the ovum by the sper- 
matozoids. It is accomplished according to some in the tubes 
or on the ovarian surface, and according to others in the 
uterine fundus. The spermatozoids penetrate the vitelline 
membrane of the ovum through the micropyle. The ovum 
then undergoes a series of progressive changes. 

Give the successive changes that take place in the ovum 
after fecundation, and during its passage to the uterus. 

1. Absorption of the vibratile extremity of the spermato- 
zoid, leaving the head only, which is known as the male pro- 
nucleus. 2. Union of the male and female pronuclei to form 
the oosperm or Mast o sphere. 3. Division of the vitelline nu- 
cleus, followed by segmentation of the vitellus, resulting in 
the formation of the morula or mulberry mass. 4. Appear- 
ance in the center of the morula of a transparent fluid, which 
condenses the morula into a thin cellular layer (blastoderm 
or blastodermic membrane). 5. Division of the blastoderm 



184 OBSTETRICS AND GYNECOLOGY. 

into the cpiblast, mesoblast and hypoblast. 6. Aggregation 
of the hypoplastic cells into the germinal or embryonic area. 

7. Appearance in this of the primitive trace or embryonic 
line, surrounded by a translucent space, the area pellucida. 

8. Incurving of the extremities of the primitive trace to form 
the fetal ellipse. 9. Development of the embryonal parts. 

Describe the vitellus, the allantois, and the amnion. 

The vitellus is the protoplasmic yelk of the ovum. The 
allantois is a small pear-shaped vesicular structure which 
develops from the lower portion of the embryonic alimentary 
canal at about the 20th day of intrauterine life. It is a vas- 
cular structure, and is the forerunner of the placenta. It is 
intimately associated with the chorion. The amnion is a 
smooth, tough, transparent, glistening, fibrous structure, the 
innermost of the fetal membranes, surrounding the fetus and 
continuous with it at the umbilicus; it secretes and encloses 
the liquor amnii. 

Describe the fully developed ovum. 

The ovum is the vital element or reproductive cell of the 
female. It varies in size from 1-500 to 1-120 of an inch. It 
consists of a protoplasmic yelk or vitellus and a nucleus or 
germinal vesicle {vesicula germinativa) enclosed within a 
hyaline covering, the zona pellucida or vitelline membrane. 

What is the character of the liquor amnii and what are 
its sources and uses? 

The liquor amnii is an alkaline fluid, about a quart in 
quantity, with a light specific gravity, an opaque white color, 
and a characteristic odor. It prevents undue pressure of the 
uterine walls upon the fetus, it saves the uterus from injury 
due to the fetal movements, it maintains an equable temper- 
ature around the fetus, and it receives and dilutes the excre- 
tions of the fetus. It is derived from the fetus largely, and 
contains much fetal urine. 

What is the umbilical cord and how is it formed? 

The funis or umbilical cord is a cord-like structure extend- 



OBSTETRICS AND GYNECOLOGY. 185 

ing from the umbilicus of the fetus to the placenta. It is 
developed from the pedicle of the allantois at about the fourth 
week of pregnancy. It measures at term about 50 cm. in 
length. 

What structures compose the fully developed umbilical 
cord? 

Two umbilical arteries, one umbilical vein, the vitelline 
duct, the pedicle of the allantois, and the j^elly of Wharton. 

What are uterine hydatids (hydatid pregnancy)? What 
are their source and treatment? 

This is an unusual name for hydatidiform mole or cystic 
disease of the chorion, -a rare affection of the chorion consist- 
ing in a proliferative degeneration of the chorionic- villi with 
the production of a mass of grape-like vesicles attached to the 
placenta. The disease occurs about once in 2000 cases of 
pregnancy. The treatment consists in immediate evacuation 
of the uterine contents. 

What changes take place in the female at puberty? 

Hair appears above the pubis; the breasts develop; the 
function of ovulation is established; menstruation appears; 
the pelvis widens ; and there is a growth of the sexual sense. 

What are the differences between the male pelvis and 
the female pelvis? Give the importance of the female 
characteristics in labor. 

Male. Heavy structure. Cavity deep and contracted. 
Sacrum narrow and slightly curved. Ischial tuberosities 
closely approximated. Subpubic angle 75°-80°. Pelvic brim 
triangular. Slight pelvic inclination. Thyroid foramen 
oval. 

Female. Light structure. Cavity shallow but roomy. 
Sacrum wide and deeply curved. Ischial tuberosities widely 
separated. Subpubic angle 90°-100°. Pelvic brim cordate. 
Great pelvic inclination. Thyroid foramen triangular. 

The female characteristics favor ready transit of a fetus 
through the pelvis. 



186 OBSTETRICS AND GYNECOLOGY. 

Give the bones, divisions, straits and symphyses of the 
obstetric pelvis. 

The pelvis is composed of the two innominate bones, the 
sacrum and the coccyx ; it is divided into the true pelvis below 
and the false pelvis above the iliopectinea] line. This line 
forms the boundary of the inlet or superior strait. The lower 
orifice is the inferior strait. The symphyses are three in num- 
ber, viz., the pubic^ and the two sacroiliac synchondroses. 

Give the obstetric landmarks of the superior and infe= 
rior straits. 

Superior strait. The four cardinal points, viz., the sacro- 
iliac synchondroses, and the iliopectineal eminences; also the 
promontory of the sacrum, and the iliopectineal line. Infe- 
rior strait. The tips of the coccyx, the ischial tuberosities, 
and the subpubic angle. 

Give the names and dimensions of the diameters of the 
pelvic inlet. 

The conjugate or anteroposterior, 11 cm. ; the transverse,. 
13% cm., and the two oblique diameters (between one ilio- 
pectineal eminence and the opposite sacroiliac synchon- 
drosis), 12% cm. 

What are the diameters of the pelvic outlet? How is 
the pelvic outlet bounded? 

The transverse (between the ischial tuberosities) 11 cm.,. 
and the conjugate (between the tip of the coccyx and the sub- 
pubic ligament) 9% cm. at rest, and 11 cm. in labor. The 
pelvic outlet is bounded by the tip of the coccyx, the ischial 
tuberosities, the sacrosciatic ligaments, the thyroid foramina, 
and the subpubic ligament. 

Differentiate the planes and axes of the pelvis and men- 
tion their obstetric importance. 

The plane of the superior strait forms an angle of 50°-6G° 
with the horizon ; the plane of the inferior strait forms a line 
Df 10° with the horizon. The roomiest portion of the pelvic 



OBSTETRICS AND GYNECOLOGY. 187 

cavity forms what is known as the plane of pelvic expansion, 
while the narrowest portion of the cavity forms the plane of 
pelvic contraction. The axis of the pelvic cavity, known as 
the curve of Cams, extends from the middle of the plane of 
the superior strait to the middle of the plane of the inferior 
strait, and follows the curve of the sacrum. The greater its 
curvature, the more difficult the labor; also the greater the 
pelvic obliquity, the more difficult the labor. 

What are the varieties of deformed pelvis? 

The most commonly recognized varieties are the simple 
flat, the spondylolisthetic, the rachitic, the coxalgic, the sco- 
liotic, the osteomalacic, Naegele's, Robert's, the kyphotic, the 
kyphoscoliotic, the justo-minor, the generally contracted and 
flat, the justo-major, the split pelvis, and the pelves distorted 
by tumors and fractures. 

What difficulties arise during labor from malformations 
of the maternal pelvis? 

If the pelvis be increased in size a precipitate labor will 
probably result. If it be contracted there will occur all de- 
grees of obstruction, from the slightest retardation to total 
blocking of the fetal progress. This will result in increased 
severity of the labor pains, rise of the contraction-ring, early 
escape of the liquor amnii, serious compression of the fetal 
head, malpositions and malpresentations of the fetus, and 
sloughing of the maternal soft parts. 

What varieties of deformed pelvis are liable to interfere 
with obstetric procedures? How? 

All pelves that are contracted in the superior or inferior 
straits will more or less seriously obstruct labor. This in- 
cludes the vast majority of deformed pelves, whatever the 
cause of the deformity. 

Describe and differentiate justo=minor pelvis and justo= 
major pelvis, and state how each may complicate labor. 

The justo-minor pelvis is one equally contracted in all of 
its diameters; it is normal in shape, but -undersized. The 



188 OBSTETRICS AND GYNECOLOGY. 

justo-major pelvis is one equally enlarged in all its diameters. 
The former obstructs labor; the latter predisposes to precipi- 
tate labor. 

Describe a nonrachitic flat pelvis, and give the man- 
agement of labor in such a condition. 

This is a very common form of pelvic deformity, consisting 
in a diminution in the anteroposterior diameter of the supe- 
rior strait of the pelvis without any disturbance in the size of 
the other diameters. As a rule, it does not result in serious 
interference of labor, although instrumental delivery may be 
required. 

What structures enter into the formation of the pelvic 
floor? 

Prom without inward the muscles of the pelvic floor are the 
transversus peronei, the ischiocavernosus, the sphincter ani, 
the sphincter vaginae, the coccygeus, and the levator ani mus- 
cles, together with the pelvic fascia and the perineal wedge 
or body. 

What changes occur in the uterus during pregnancy? 

There is a general hypertrophy of all the uterine tissues, 
especially of the muscular substance. The blood-vessels are 
increased in number, size, length and tortuosity. The veins 
lose all their coats but the intima. The uterus slightly ro- 
tates on its axis from left to right during its development. 

What are the effects of pregnancy on the maternal 
organisms? 

In addition to the uterine changes already described there 
will be noted the following : A deposit of fat in the abdominal 
wall, an edema of the joints of the pelvis, congestion of the 
pelvic viscera, an increase in the quantity of blood and of the 
urine, alterations in taste and disposition, and a softening of 
the bones of the entire body. 

What changes occur during pregnancy in the external 
genitals and vagina? 

There will be noted an increased vascularity, with edema 



OBSTETRICS AND GYNECOLOGY 189 

and softening of the tissues, and a bluing of the mucous mem- 
brane. 

What changes occur in the breasts during pregnancy? 

The breasts become enlarged generally and much engorged, 
and a deposit of pigment takes place in the areola. This pri- 
mary ring of pigment may be surrounded by a secondary 
areola of light color. The glands of Montgomery become 
enlarged and protuberant. The nipples become prominent, 
and colostrum develops in the mammary glands. 

What changes occur in the blood during gestation? 

The general quantity of the blood is increased, while its 
quality decreases; in other words, there exists a combined 
hydremia and anemia. There is an increased tendency to 
clot from the large amount of fibrinogen present. 

Describe the human embryo during the second month, 
during the fifth month, during the seventh month, and 
during the ninth month, giving size and weight. 

At the second month the embryo is the size of a pigeon's 
egg; the visceral clefts are closed; the head forms more than 
two-thirds of the embryo, and all its features may be distin- 
guished; the hands and feet are webbed; the length of the 
fetus is 4 cm. (iy 2 inches) ; its weight is 4 grams (60-62 
grains) . 

At the fifth month the face is wrinkled and senile, the hair 
and nails are fully formed, the vernix caseosa appears, the 
eyelids begin to open; the umbilical cord is about 12 inches 
long; the length of the fetus is about 25 cm. (9% inches) ; 
its weight 273 grams (10 8-10 ounces). 

At the seventh month the skin is still wrinkled and reddish, 
the lanugo begins to disappear from the face, the eyelids are 
open, the membrana pupillaris disappears; the length of the 
fetus is 35 cm. (13% inches) ; its weight 1213 grams (39 
ounces). 

At the ninth month the senile appearance of the face dis- 
appears, the lanugo begins to disappear from the body; the 



190 OBSTETRICS AND GYNECOLOGY. 

length of the fetus is 45 cm. (17% inches) ; its weight 1990 
grams (5% pounds). 

Name the diseases of the fetus and its membranes in 
utero. 

The fetus may suffer from various infectious diseases trans- 
mitted to it through the placental circulation; rarely it may 
develop tuberculosis in this way; fetal rickets is a common 
condition, as is also fetal syphilis; very rarely the fetus may 
develop tumors in various portions of the body; maternal 
impressions may be noted; and various intracranial diseases, 
as meningocele, hydrocephalus and the like; fetal ichthyosis 
is rarely noted. The diseases of the membranes include 
hydramnias, oligohydramnios, and cystic disease of the cho- 
rion. 

How would you diagnose the death of the fetus in utero? 

In about the order of value the signs of fetal death are : 1. 
Cessation of abdominal and uterine growth, followed by sub- 
sidence in the size of the uterus. 2. Subsidence of the signs 
of pregnancy. 3. Absence of fetal heart-sounds and fetal 
movements. 4. Absence of pulsation in the umbilical cord or 
fetal precordium. 5. Decrease in the cervical temperature. 
6. Appearance of milk in the breasts (occasional). 7. Pep- 
tone or acetone in the urine. 8. Cranial crepitus in case of 
maceration of the fetus. 

How may death of the fetus in utero be recognized after 
the period of viability? What should be done in such 

cases? 

Fetal death may be presupposed by a suppression of all 
the signs of pregnancy that have been present; by absence 
of the fetal heart-sounds; by cessation of the growth of the 
abdomen, with subsequent diminution in the size of the 
abdominal girth, and occasionally by the appearance of milk 
in the breasts. When fetal death is assured the uterine con- 
tents should be removed. 



OBSTETRICS AND GYNECOLOGY. 191 

Give the obstetric anatomy of the fetal head. 

The fetal head at term consists of the two frontal bones, 
the two parietal bones, the occiput and the bones of the face. 
These various bones are separated by sutures, as follows; 
The frontal, the sagittal, the coronal, the lambdoid, and by 
the two fontanels, the anterior and the posterior. 

Name the various diameters of the fetal head. 

The diameters of the fetal head are as follows : The bitem- 
poral, 8 cm. ; the biparietal, between the two parietal emi- 
nences, 914 cm. ; the bimastoid, between the two mastoid 
processes, 7% cm. ; the occipitofrontal, from the root of the 
nose to the external occipital protuberance, 11% cm. ; the 
occipito-mental, from the point of the chin to the external 
occipital protuberance, 13% cm. ; the suboccipito-bregmatic, 
from the central point of the bregma to a point midway be- 
tween the occipital protuberance and the foramen magnum, 
9% cm. ; the frontomental, from the top of the forehead to the 
point of the chin, 8 cm. ; the trachelo-bregmatic, from the 
central point of the bregma to the anterior margin of the 
foramen magnum, 9% cm. ; and the mento-bregmatic or 
cervico-bregmatic, from the central point of the bregma to 
the junction of the chin and neck, 9!/4 cm. 

Describe the fontanels and their diagnostic uses. 

The anterior or larger fontanel or bregma is a diamond- 
shaped space left at the point of junction of the frontal, 
coronal and sagittal sutures. The posterior or smaller fon- 
tanel is situated at the point of junction of the lambdoid and 
sagittal sutures, and is triangular in shape. It is felt in all 
normal vertex presentations, and by its situation determines 
the position of the head in labor. The bregma is never felt 
in a normal presentation, but may be palpated in the presen- 
tation of the top of the head, in a brow presentation, and in 
presentation of the occiput in the hollow of the sacrum. 

What is meconium and what are its diagnostic relations? 

Meconium is the peculiar greenish substance contained in 



192 OBSTETRICS AND GYNECOLOGY. 

the fetal bowels at birth. If it be discharged prior to the 
delivery of the child, it generally indicates a breech pre- 
sentation. Occasionally it will escape in difficult head- 
deliveries. 

Describe the fetal heart=sounds, give their rate, and 
state when and where they are best heard. 

The fetal heart-sonnds constitute an absolute sign of preg- 
nancy from the sixth month of gestation on. They resemble 
the ticking of a watch under a pillow; their rate is about 
twice that of the maternal heart-beat, averaging from 120 to 
160 beats a minute. The position of maximum intensity 
varies according to the fetal presentation. In anterior ver- 
tex presentations they are best heard at a point midway be- 
tween the umbilicus and the anterior spinous process of that 
side upon which the fetus is resting, while in posterior vertex 
presentations the point of maximum intensity would be in 
the corresponding flank, slightly below a transverse line pass- 
ing through the umbilicus. 

What is ballottement, and how is it performed? 

Ballottement is a balancing of the fetus in utero between 
the fingers of the two hands. In vaginal ballottement the 
index and middle fingers of the left hand are inserted into the 
anterior vaginal fornix, the patient lying in the dorsal posi- 
tion, while the fundus is steadied by the right hand placed 
upon the abdomen. The vaginal fingers give a sudden im- 
pulse to the anterior uterine wall, whereby the fetus is dis- 
placed upward; the latter gently falls back and strikes upon 
the propelling fingers. This sign is positive, and is available 
from the middle of the fourth to the eighth months. 

How would you diagnose pregnancy at five months, at 
or before the end of the third month, and at full term? 

In the first three months of pregnancy the following signs 
are present: Menstrual suppression, nausea and vomiting, 
and the four soft signs, viz., Goodell's sign (softened cervix), 
Hegar's sign (softened lower uterine segment), the soft and 



OBSTETRICS AND GYNECOLOGY. 192 

boggy uterine body, and the soft and enlarged mammae, with 
the darkened areolae. 

At the fifth month there will be added to the foregoing 
Jacquemin's sign (the bluing of the vaginal and vulvar 
mucosae), Braxton Hicks' intermittent uterine contraction, 
ballottement, and quickening; the uterus will also be con- 
siderably more enlarged. 

At term all the foregoing signs are present, save ballotte- 
ment, and in addition the fetal heart-sounds may be detected, 
and palpation will reveal the fetal outlines both above and 
below. 

What are the subjective signs of pregnancy? 

The subjective signs of pregnancy are those recognized by 
the patient herself. This includes menstrual suppression, 
nausea and vomiting, vesical irritability, quickening, pain in 
the abdominal walls from excessive distension, vertigo, palpi- 
tation, and gastric disturbance. 

What signs of pregnancy are determined by the touch? 

The four "soft signs," the fetal parts and presentation, 
ballottement, Braxton Hicks' sign, the uterine enlargement, 
and the fetal movements. 

What may be learned by abdominal palpation of the 
pregnant woman after the eighth month? 

The fetal movements, the fetal parts, the position and pre- 
sentation of the fetus, the size and position of the uterus, the 
degree of distension of the uterine and abdominal walls, the 
size of the pelvic inlet, the movability of the fetal head. 

Classify the objective signs of pregnancy and state their 
relative value. 

The five positive signs of pregnancy are ballottement, fetal 
movements, fetal heart-sounds, blue discoloration of the vulva 
and vagina, and intermittent uterine contractions. Other 
valuable objective signs are cervical softness (in primiparae), 
Hegar's softening of the lower uterine segment, darkening 



194 OBSTETRICS AND GYNECOLOGY. 

of the areolae of the breasts, the presence of colostrum in the 
breasts, and the outlining of the fetal parts. 

What are the signs of pregnancy, doubtful, probable, 
and certain? 

The doubtful signs of pregnancy are vesical irritability, 
irregular gastric disturbances, increasing constipation, dimin- 
ution but not actual suppression of the menstrual flow, all 
occurring in a woman exposed to the possibility of impreg- 
nation. 

The probable signs are total menstrual suppression, in- 
creasing size of the uterus, darkening of the mammary 
areolae, development of Montgomery's tubercles, and fre- 
quency of micturition. 

The certain signs are the positive signs already enumerated. 

What is to be learned by abdominal auscultation in 
pregnancy? 

Auscultation of the abdomen will reveal the placental 
souffle or uterine bruit and the fetal heart-sounds. Occasion- 
ally the umbilical souffle may be detected. 

Describe the changes in position which the uterus under= 
goes during pregnancy. 

At first the uterus sinks into the pelvis on account of its 
increased specific gravity. There then follows a gradual and 
progressive rise into the abdomen until 2 to 4 weeks before 
term, when a secondary sinking (lightening) occurs, due to 
the entrance of the fetal head into the superior strait. 

At what period does quickening usually occur? 

In the middle of the fifth month of gestation. 

How should external palpation of the pregnant woman 
be performed? 

The woman lies in the dorsal position with the limbs partly 
flexed. General pressure is made with the tips of the fingers 
and the ulnar borders of the palms upon the abdominal sur- 
face from the median line towards the flanks. The hands 



OBSTETRICS AND GYNECOLOGY. 195 

are permitted to dip beneath the central points of Poupart's 
ligaments and beneath the pelvic brim in order to determine 
the fetal presentation. 

What is " morning sickness," when does it begin, how 
long does it usually continue, and what is its causation 
and treatment? 

The nausea and vomiting of pregnancy occurs usually at 
the sixth week of gestation, and normally lasts for six weeks. 
It may begin earlier or it may not appear at all. It is be- 
lieved to be due to a reflex irritation of the nerve-endings in 
the uterus resulting from the rapid growth of that organ. 
It is best treated by the exhibition of nerve-sedatives, such as 
sodium bromide, ingluvin, oxalate of cerium and the like. 

Differentiate ordinary morning sickness from the hy= 
peremesis of pregnancy. Mention the causes and describe 
the management of the latter. 

The pernicious vomiting of pregnancy is an exaggerated 
gastric disturbance Avhich appears to become uncontrollable, 
and may result fatally from extreme prostration. It is due 
to a number of conditions, including the presence of toxins 
of undetermined nature in the blood, probably resulting from 
imperfect functionating of the liver. It occurs in women 
whose uteri have been chronically diseased, and in those who 
are of a neurotic tendency. It may also result from kidney- 
failure, and from too frequent sexual intercourse. Its treat- 
ment consists in proper hygiene, the correction of uterine 
displacements or cervical catarrh, restriction in diet, the use 
of proper therapeutic measures, and, if need be, rectal ali- 
mentation. The pregnancy should be terminated if the other 
measures fail. 

What is the normal duration of pregnancy? What are 
the limits of the variations, and how should its duration 
be calculated? 

From a number of investigations it has been found that in 
the human being pregnancy normally covers 280 days (10 



196 OBSTETRICS AND GYNECOLOGY. 

lunar or 9 calendar months). It may be extended up to 302 
days and pregnancy still be considered legitimate. Fre- 
quently the pregnancy terminates prematurely, and this may 
happen at any time subsequent to conception. The methods 
of determining the date of confinement are numerous. The 
Naegele rule is to count back 3 months from the date of the 
appearance of the last menstruation and add 7 days. The 
date of quickening usually occurs midway through gestation, 
or at 41/2 months. Other methods consist in mensuration of 
the uterus and of the fetus, and the use of periodoscopes and 
tables. 

How would you differentiate between the first and 
subsequent pregnancies? 

In a primipara the fourchet is present; it is missing in a 
multiparous woman. The abdominal walls are relaxed and 
marked with striae in the multipara, while in the primipara 
the abdomen is full, rounded and tense. The nipples are 
large and well developed in the multiparous woman, and 
usually small and undeveloped in the primipara. 

Given a distended abdomen, how would you differen= 
tially diagnose pregnancy, ovarian disease, ascites, and 
gaseous accumulation? 

In ovarian cyst there is generally an absence of the chief 
signs of pregnancy; the characteristic ovarian facies is pres- 
ent; the abdominal tumor is soft, fluctuating, usually more 
or less directed to one side, and does not reveal the fetal signs ; 
continuance of menstruation is the rule ; the cervix is not 
unduly soft; and the history is obscure, the growth slowly 
developing for a longer period than the full term of gestation. 

In ascites percussion shows dullness in the flanks, with re- 
sonance in the median abdominal line, the area of dullness 
changing with the position of the patient; there is free fluc- 
tuation; the usual signs of pregnancy are absent; the abdo- 
men is flattened in the umbilical region, with bulging at the 
sides; the umbilicus is always depressed; palpation does not 
reveal any definite tumor; the cervix is not altered. 



OBSTETRICS AND GYNECOLOGY. 197 

In gaseous accumulation or pseudocyesis, which most com- 
monly occurs in elderly women at or near the menopause or in 
young or hysterical women, some of the important signs of 
pregnancy will be absent ; the uterus is not enlarged, and the 
cervix is not soft; there is a tympanitic percussion-note over 
the whole abdominal surface, and if the patient be anesthe- 
tized the abdominal enlargement will disappear entirely. 

Differentiate uterine bruit and umbilical souffle. 

The uterine bruit or placental souffle is a rythmic blowing 
sound occurring synchronously with the maternal heart-beat. 
It is first heard about the beginning of the fourth month, and 
is generally located low down and to one or the other side of 
the uterus. It is also known as the placental murmur. The 
umbilical or funic souffle is a peculiar high-pitched hissing 
sound heard most distinctly in the immediate vicinity of the 
fetal heart, with the beat of which it is synchronous. It is a 
sign of fetal danger, and indicates some stenosis of the um- 
bilical arteries. 

Describe the mammary glands and the changes they 
undergo in pregnancy. When the child is still=born what 
care should be taken of the mother's breasts? 

The mammary glands are two large glandular structures 
on the anterior surface of the thorax. They consist of a num- 
ber of lobules, each of which has an excretory or galacto- 
phorous duct which runs to the nipple. . During pregnancy 
the breasts enlarge and become firm and heavy. Glistening 
streaks appear upon the surfaces from over-distension. Pig- 
ment is deposited around the nipple in the areolae ; the glands 
of Montgomery enlarge and protrude from the surface; the 
nipples increase in size and become prominent and protrud- 
ing. Colostrum appears in the breasts after the third month. 
If the child is still-born the breasts must be strapped and 
applications made to prevent the development of milk. 

State the medicolegal complications that may arise from 
an erroneous diagnosis of pregnancy. 

An erroneous diagnosis of pregnancy may result in con- 



198 OBSTETRICS AND GYNECOLOGY. 

jugal unhappiness, with divorce; it may cause the execution 
of an innocent woman or unnecessary confinement in prison; 
it may alter the terms of a will or the dividing of an estate; 
it may bring a law-suit against the physician. 

What are the positions and attitudes of the fetus in 
utero, and what are their causes? 

The fetus may lie parallel with or at right angles to the 
long axis of the woman 's body ; it always lies in the long axis 
of the uterus, whether this be' horizontal or vertical. It may 
lie obliquely if there exist a tumor or thickening in the uterine 
Avail, or if the uterine cavity be irregular in its outlines. 

How many different presentations are liable to be met 
in obstetric practice? What are they? 

There are three presentations of the fetal body, viz., the 
cephalic or head, the pelvic, and the transverse or trunk. 
The cephalic presentations include the vertex, face, bregma 
or anterior fontanel, brow, ear, and parietal eminence. The 
pelvic presentations include the breech, knee, and foot. 

How is a vertex presentation recognized by palpation? 

Examination of the abdomen shows the hard cephalic ex- 
tremity of the child at the pelvic brim; vaginal examination 
reveals the depressed occiput and smaller fontanel at one 
extremity of a pelvic diameter, while the sagittal suture 
extends obliquely from them in the line of the diameter. 

Differentiate the positions of the fetus at term as deter= 
mined by external palpation. 

Cephalic or head presentations show the fetal ellipse lying 
longitudinally, with the fetal back to one or the other side 
and the hard cephalic extremity at the pelvic brim; fetal 
movements are felt high up on the abdominal surface. In 
pelvic presentations the conditions are reversed, the head 
above and the breech below; the head may be freely moved, 
and the fetal movements are felt low down on the abdominal 
surface. In transverse presentations the long axis of the 



OBSTETRICS AND GYNECOLOGY. 199 

fetus lies at right angles to the long axis of the mother's body; 
both extremities of the fetal ellipse may be readily palpated. 

How may the knee be distinguished from the elbow 
when presenting? 

The knee is round and large, the elbow small and more 
angular; the elbow shows sharp bony processes to the sides 
and posterior; the popliteal space may be felt behind the 
knee; the arm may readily be brought down if the elbow is 
present; the leg is brought down with more difficulty. 

What is understood by the hygiene of pregnancy? In 
a case of pregnancy how is the health of the patient main= 
tained? 

By the hygiene of pregnancy is meant the management of 
the patient according to the rules of health. This includes 
regulation of the diet, clothing, exercise, bathing and douch- 
ing, and sexual intercourse; attention to the kidneys and 
other emunctories; the correction of constipation and proper 
occupation for the mind. 

Describe the proper management of the breasts of the 
mother before labor. 

Proper development of the nipples should be favored by 
judicious manipulation daily. The nipples should be kept 
clean by soap and water and a weak solution of sodium borate. 
If the breasts are painful they may be anointed at night with 
cocoa-butter or lanolin. 

What is the pathology of pregnancy? Name some of 
the diseases to which pregnancy predisposes. 

The pathology of pregnancy includes a study of the dis- 
eases to which a pregnant woman is exposed. The diseases 
she is most apt to develop are renal insufficiency, Bright 's 
disease, gingivitis, salivation, pica, indigestion, pernicious 
vomiting, constipation, hemorrhoids, jaundice, appendicitis, 
dyspnea, cardiac palpitation, hydremia, pernicious anemia, 
varicose veins, hemorrhage, uterine displacements, insanity, 
neuralgias, and osteomalacia. 



200 OBSTETRICS AND GYNECOLOGY. 

To what form of morbus Brightii are pregnant women 
most liable? How would you diagnose and treat it? 

To acute nephritis, catarrhal or interstitial in nature. It 
is frequently so called when in reality the kidney of preg- 
• nancy is meant. 

Give the etiology, symptoms and management, as best 
understood and practiced at present, of albuminuria of 
pregnancy. What is the prognosis? 

By the albuminuria or kidney of pregnancy is meant a 
peculiar condition manifested by a certain proportion of 
pregnant women in which albumen appears in the urine in 
varying amounts, but which is unassociated with any grave 
organic change in the kidneys. The condition is one of hemic 
intoxication, the poisons probably originating in an imper- 
fect metabolism on the part of the liver. The poisons irritate 
the kidneys, producing an arteriole contraction, whereby the 
kidneys appear pale and anemic, and become inadequate to 
perform the work devolved upon them. The treatment of 
renal inadequacy consists in a careful supervision of the 
condition of the urine, and appropriate dietetic, hygienic and 
therapeutic regimen. Milk diet or light diet, large draughts 
of Poland or lithia water, diuretics, laxatives, alteratives, 
Basham's mixture, irrigation of the bowel with hot normal 
saline solutions, and the bromids and chloral hydrate consti- 
tute the treatment. If the disease progresses labor may have 
to be induced. The prognosis is always anxious. 

How would you measure the severity of interstitial 
nephritis in a pregnant woman, and how would you treat 
such a condition? 

By the early appearance of the symptoms, by the number 
and nature of the urinary casts, by the development of albu- 
minuric retinitis, and by the rapidly increasing edema. The 
disease requires an early evacuation of the uterine contents. 

What is the cause of difficult and painful urination in 
pregnancy? 

When present this generally results from uterine displace- 



OBSTETRICS AND GYNECOLOGY. 201 

ment backward, the cervix tilting up against the base of the 
bladder and interfering with micturition. 

How do uterine displacements originate, and how do 
they influence conception and pregnancy? 

Uterine displacements are generally the result of previous 
labors, the floor being lacerated and the uterus remaining 
subinvoluted and heavy. Such an organ falls back into the 
hollow of the sacrum. Anteflexion of the uterus may result 
from a ventrofixation. Any fixed displacement is apt to pre- 
vent conception by rendering the ingress of the spermatozoids 
impossible, and if pregnancy results and the displacement 
persists, abortion is apt to occur spontaneously. 

What uterine displacement is especially liable to inter= 
rupt pregnancy, and what should be done to prevent it? 

Retrodisplacement. Such a displaced uterus should be 
replaced at once, and a pessary introduced and retained until 
the fundus rises above the sacral promontory (fourth month) ; 
it may then be withdrawn. 

What treatment would you advise for a case of con= 
tinued menstruation during pregnancy? 

Such a condition indicates failure of union between the 
decidua vera and decidua reflexa. The patient should be 
kept quiet, especially at the menstrual epochs. No local 
treatment is indicated as a rule. If the hemorrhage becomes 
profuse the treatment of threatened abortion must be insti- 
tuted. 

Name the diseases of the endometrium, and state their 
effects in pregnancy. 

Inflammation {endometritis), acute or chronic, will tend 
to produce abortion. Chronic endometritis, especially if 
syphilitic in origin, is probably the most common cause of 
abortion. Atrophy of the decidua (hypertrophied endome- 
trium) causes the ovum to drop in the uterine cavity, and 
may result in placenta prsevia. A catarrhal endometritis 
may cause an accumulation of fluid between the layers of the 



202 OBSTETRICS AND GYNECOLOGY. 

decidua, producing the condition known as hydrorrhea gravi- 
darum, or "false waters." Apoplexy of the decidua may- 
destroy the ovum. Tumors may form in the decidua rarely^ 
if benign they are known as benign deciduomata; malignant 
deciduoma is rarely encountered. 

What diseases of the mother are liable to injure the 
fetus in utero? 

Syphilis, tuberculosis, rickets, the exanthemata, renal in- 
adequacy, puerperal eclampsia; any disease causing stagna- 
tion in the circulation, as chronic valvular disease and spas- 
modic maternal affections, as bronchitis, chorea and the like. 

Mention some of the principal causes of sterility in 
woman, and state how fertility may be promoted. 

Stenosis of the cervical canal from anteflexion, retrodis- 
placement of the uterus, cervical catarrh with profuse acrid 
leukorrhea, chronic salpingitis resulting in occlusion of the- 
Fallopian tubes, and chronic endometritis. Rapid progressive 
dilatation of a stenosed canal, replacement of a displaced 
uterus, the local treatment of cervical catarrh and uterine- 
disease will do much to restore a normal condition and pro- 
mote fertility. 

Define abortion, miscarriage, and premature labor. 

Abortion is the discharge of the ovum during the first tri- 
mester of pregnancy. Miscarriage is the discharge of the- 
embryo during the second trimester. Premature labor is the 
delivery of the fetus after the period of viability and before 
full term. 

What is the management of abortion, both preventive 
and curative? Give its causes, diagnosis, and indications 
for treatment. 

The causes of abortion are numerous. They include cer- 
tain morbid states of the ovum and fetus, as apoplexy of the 
ovum, disease of the umbilical vesicle, disease of the fetal 
membranes, malposition of the placenta, disease of the fetus, 
as syphilis and hydrocephalus, death of the fetus, certain 



OBSTETRICS AND GYNECOLOGY. 203 

paternal causes, as a diseased spermatozoid, certain maternal 
diseases, as the exanthemata, valvular heart-disease, renal 
inadequacy, convulsive disorders, as chorea and epilepsy, 
malformations of the uterus, profound mental shock, and 
traumatism. 

The symptoms of abortion are sacral discomfort, steadily 
increasing hemorrhage, uterine contractions, and finally ex- 
pulsion of a part or the whole of the product of conception. 
The diagnosis may be made by a study of the symptoms, by 
the physical signs, and by an examination of the discharged 
products. The preventive treatment consists in absolute 
quiet and rest in bed, lowering of the head, the administra- 
tion of nerve-sedatives, as sodium bromid, and the introduc- 
tion of an opium suppository. The curative treatment con- 
sists in vaginal and cervical tamponade to control bleeding, 
followed by emptying of the uterine contents. 

What are the premontory symptoms of abortion? 

At the best these are vague and unreliable. They consist 
in a sense of discomfort or fulness in the pelvis, sacral pains, 
a feeling of malaise, a tendency to vesical tenesmus, chilly 
sensations, and beginning discharge of serum or blood from 
the uterus. 

What are the symptoms of threatened abortion? 

Pain, increasing hemorrhage, and opening of the uterine 
mouth. 

Describe the symptoms and give the management of an 
incomplete abortion. 

The body of the uterus will be large, soft and boggy; the 
cervical canal will be patulous; the finger introduced into 
the cavity of the womb will detect clots, fragments of mem- 
brane and pieces of soft, pulpy, placental tissue ; the discharge 
will be dark, hemorrhagic and grumous, and there may or 
may not be a fetid odor. The treatment consists in the asep- 
tic removal of the uterine contents by means of the finger or 
placental forceps, followed by an intrauterine douche of mer- 



204 OBSTETRICS AND GYNECOLOGY. 

curie chlorid, 1-4000, and the administration of small doses 
of ergot if the hemorrhage persist. 

What are the symptoms of an inevitable abortion? 

Steadily increasing hemorrhage and pain despite the pre- 
ventive treatment, and the presence of Tarnier's sign, namely, 
obliteration of the angle of flexion between the upper and 
lower uterine segments by the descent of the detached ovum. 

What means should be employed to prevent threatened 
abortion during the first three months of pregnancy? 

The avoidance of over-exertion, the correction of uterine 
displacement, rest in bed at the menstrual epochs, the admin- 
istration of sodium bromid, viburnum prunifolium and other 
sedatives, and occasionally the use of an opium suppository. 

How should inevitable abortion be managed? 

A vaginal and intracervical tampon should be introduced 
and left in situ for 8 hours. On its removal the ovum will 
probably be found attached to it. If not, a second tampon 
may be introduced and retained for from 6 to 8 hours. If this 
fails to bring the ovum away the patient should be anesthe- 
tized and the product removed by the finger or the placental 
forceps. 

When and how should abortion be induced? 

The induction of abortion is indicated when maternal life 
is menaced by some grave pathologic state of the fetus or of 
the mother, as cystic disease of the chorion, acute hydramnios, 
large uterine or pelvic tumors, extreme pelvic contraction, 
pernicious vomiting, pernicious anemia, chronic nephritis 
and the like. The best method of inducing abortion consists 
in rapid dilatation of the cervix after thorough asepsis of the 
vagina, with the immediate removal of the ovum by the finger 
and placental forceps. 

Is the production of premature labor ever justifiable? 
If so, when and how would you accomplish that object? 

The indications for the induction of premature labor in- 



OBSTETRICS AND GYNECOLOGY. 205 

elude all conditions menacing fetal or maternal life, as well 
as those pathologic states of either mother or child that will, 
if the pregnancy be allowed to continue to term, be productive 
of grave degrees of dystocia. These are, oversize or prema- 
ture ossification of the upper portion of the fetal skull, acute 
hydramnios occurring late in pregnancy, habitual death of 
the fetus during the last days or weeks of pregnancy, pelvic 
deformity, placenta praevia, pernicious anemia, pernicious 
vomiting, increasing albuminuria, eclampsia, grave valvular 
disease, advanced pulmonary tuberculosis, tumors in the pel- 
vic canal. The best method of inducing labor is the intro- 
duction of an aseptic rubber catheter into the uterus. Other 
methods inchfde the use of Barnes' or Champetier de Kibes' 
bags, and rapid digital divulsion of the cervix with the per- 
formance of podalic version. 

Define and classify ectopic pregnancy. Give its causes, 
symptoms and treatment. 

Ectopic or extrauterine pregnancy is a generic term mean- 
ing pregnancy at any point outside of the uterus. This 
includes tubal pregnancy , interstitial pregnancy, tubo-ovarian 
pregnancy, ovarian pregnancy, and primary and secondary 
abdominal pregnancy. The causes of this condition are un- 
known. The condition is generally encountered in women 
who are between 20 and 30 years of age, and who present a 
history of a protracted period of sterility following one or 
more pregnancies. It was formerly believed to be due to a 
salpingitis, but Sutton now states that it is more liable to 
occur in a healthy tube. Tubal diverticula may produce it. 
The symptoms are the presence of all the signs of early ges- 
tation, irregularity in the menstrual history, vaginal pulsa- 
tion, lancinating, cramp-like pains in the affected side, slight 
elevation of temperature, and lateral displacement of the 
uterus by a very sensitive mass. The treatment consists in 
immediate abdominal section and removal of the gestation-sac. 

What are some of the possible terminations of a tubal 
pregnancy? 

Tubal pregnancy may terminate in rupture, which is usual. 



206 OBSTETRICS AND GYNECOLOGY. 

In a certain percentage of cases the embryo may die within 
the first few weeks of gestation; this is known as the sponta- 
neous cure of extra-uterine pregnancy. Rarely the condition 
may go to term. 

What are the symptoms of rupture in ectopic preg= 
nancy? What should be done when such rupture occurs? 

The symptoms of rupture are sudden and characteristic. 
They consist in exceedingly severe cramp-like pains in the 
iliac region of the affected side, associated with collapse and 
the symptoms of concealed hemorrhage, namely, extreme 
pallor of the surface, feeble running pulse, air-hunger, moist, 
clammy skin, coldness of the extremities, vomiting, and fre- 
quently coma. There is an increased discharge from the 
vagina ; large masses of decidual tissue are usually discharged 
at this time. Immediate laparotomy should be performed. 

What preliminary preparations would you suggest for 
a case of labor? 

The thorough disinfection of the physician, nurse and 
patient according to the accepted methods, the opening of the 
patient's bowels by means of a rectal enema, the proper 
preparation of the patient's clothing and bed. The nurse 
should have on hand the various drugs and instruments, as 
well as hot water, for whatever obstetric operation may be 
required. 

What is labor? 

Labor is that natural process by which a pregnant woman 
expels the product of conception at the full expiration of the 
period of pregnancy, 280 days after conception. 

Into what stages is labor divided, and where do these 
stages begin and end? 

There are three stages of labor. The first or stage of dila- 
tation begins with the first labor pain and continues until the 
os is fully dilated. The second stage or stage of expulsion 
extends from full dilatation until the delivery of the child 
is accomplished. The third stage or stage of the placenta 



OBSTETRICS AND GYNECOLOGY. 207 

extends from the delivery of the child until the expulsion of 
the after-birth. 

What are the prodromata of labor? 

The onset of labor is indicated from 2 to 4 weeks before by 
the phenomenon known as lightening. This is produced by 
the entrance of the child's head into the superior strait, and 
occurs 2 weeks before term in multiparas and 4 weeks before 
term in primiparas. The symptoms of beginning labor are 
pain, beginning dilatation of the os, and a bloody discharge 
known as the show. 

What is the diagnosis of false from true labor pains? 

False labor pains are annoying, colicky sensations occur- 
ring during the last 2 or 3 weeks of pregnancy, which usually 
depend upon constipation or pressure upon nerve-trunks. 
They are irregular in their location, and are not accompanied 
by dilatation of the os. True labor pains are involuntary 
and painful contractions of the uterine muscles occurring 
intermittently and with increasing severity at decreasing in- 
tervals. They are usually felt in the small of the back, and 
from this point pass around the abdomen. They may reverse 
this direction, and, commencing at the umbilicus, pass back- 
ward to the sacrum. They are cumulative in nature, of 
unequal intensity, and last from one-half to one minute. 
They result in dilatation of the os. 

Give the character, situation and cause of the pains 
during the first and second stages of labor. 

During the first stage of labor the pains are as described in 
the foregoing answer. They result from squeezing of the 
nerve-fibrils by the contracting of the uterine muscles. They 
are colicky in nature, and aside from opening the os do not 
favor the expulsion of the child. In the second stage of labor 
the character of the pains changes. They become bearing- 
down or expulsive in nature. The pain now is due to pres- 
sure upon the soft tissues of the lower parturient canal, as 
well as to the pressure upon the nerve-fibrils above. 



208 OBSTETRICS AND GYNECOLOGY. 

What means are employed to stimulate ineffective 
uterine contractions? 

The administration of quinin in large doses, the application 
of a firm abdominal binder, keeping the woman upon her feet, 
and the taking of a small amount of food may all result in an 
increase of the uterine pain. Ergot or its substitutes should 
not be administered. 

What is meant by the mechanism of labor? 

By the mechanism of labor is meant the manner in which 
the fetus and secundines pass through the parturient canal 
and are expelled. 

Define and differentiate position, presentation and 
rotation. 

By position is meant: 1. The varying relationship borne 
by the most prominent point of the presenting part of the 
fetus to the cardinal points of the pelvis. 2. The relationship 
existing between the long axis of the fetus and that of the 
maternal body. 

By presentation is meant that portion of the fetal body 
which is detected by the examining finger introduced to the 
center of the plane of the superior strait. 

By rotation is meant the turning of the presenting part 
from right to left or left to right after it has struck the pelvic 
floor, so that it comes to present under the pubic symphysis. 
External rotation is a return of the presenting part to the 
side from which it comes after it has been delivered through 
the vulvar orifice. 

Give the normal vertex presentations in the order of 
their frequency. 

1. Left occipito-anterior, L. 0. A.; 2. Right occipito-pos- 
terior, R. 0. P. ; 3. Right occipito-anterior, R. 0. A. ; 4. Left 
occipito-posterior, L. 0. P. 

What is the most common presentation and which the 
most frequent position of the presenting part in normal 
labor? Give the average duration of a natural labor. 

The most common fetal presentation is the occipital or 



OBSTETRICS AND GYNECOLOGY. 209 

vertex; the most frequent position is the left occipitoanterior 
L. 0. A. The average duration of labor in a primipara is 
from 12 to 15 hours ; in a multipara from 8 to 10 hours. 

Give the formation of the caput succedaneum. Where 
does the caput succedaneum appear in the third position? 

The caput succedaneum or "accessory head" is the tumor 
situated upon the presenting part of the fetus. It is formed 
by a serosanguineous infiltration of the connective tissue of 
the part. It is due to an edema of the part that is not com- 
pressed by the maternal structures. In the third position 
of the vertex, R. 0. P., the caput appears on the left parietal 
eminence. 

Describe the mechanism of labor in L. O. A. presen= 
tation. 

Adaptation of the fetal presentation to the pelvic strait. 
It consists of three steps, namely, preliminary flexion and 
moulding occurring with the phenomenon of lightening; fur- 
ther flexion and moulding occurring with the first labor pains ; 
and Naegele 's obliquity, or lateral inclination of the fetal head 
toward the maternal sacrum, the right parietal bone present- 
ing. The birth-canal is next prepared by being dilated by 
means of the bag of waters. The presentation next descends 
to the pelvic floor, the occiput resting on the floor. Internal 
anterior rotation of the occiput from left to right now occurs, 
the occiput resting beneath the smyphysis pubis. Birth of 
the head by a process of extension follows, the perineum 
retracting over the face, which appears first at the forehead 
and eyes and finally at the chin. Restitution or untwisting 
of the neck is then followed by external rotation of the head, 
which becomes transverse, with the occiput to the left side. 
The birth of the shoulders follows, the anterior or right shoul- 
der rotating from right to left; the rest of the trunk is then 
rapidly expelled. 

Describe the mechanism of labor in the L. O. P. position. 

The steps of the mechanism are the same as in the foregoing 
14 



210 OBSTETRICS AND GYNECOLOGY. 

except that the head has further to rotate in order to reach 
the symphysis, and this excessive rotation requires a rotation 
of the shoulders at the superior strait from the right into the 
left oblique diameter, the anterior shoulder rotating from 
left to right. After restitution this shoulder rotates back 
again to the middle line from right to left. The rest of the 
mechanism is as in the L. 0. A. presentations. 

Name and describe the various forms of head=presenta= 
tion, with the management appropriate to each. 

The vertex presentation is most common; its management 
is that of an ordinary case of labor. Brow and face presen- 
tations are always abnormal, and will be described further 
on. Presentation of the bregma is the so-called "military posi- 
tion ' ' of the fetus, the head being midway between flexion and 
extension, and set squarely on the shoulders. The large 
occipito-frontal diameter of the fetal skull (11% cm.) pre- 
sents. This presentation must be converted into an occipital 
presentation in order to permit labor to proceed. Ear pre- 
sentation is a laterally deviated vertex presentation, and can 
generally be corrected manually or by altering the position 
of the patient. 

Give the face and breech presentations of the fetus. 

The face presentations are: 1. Left mento-anterior, L. M. 
A.; 2. Right mento-anterior, R. M. A.; 3. Right mentopos- 
terior, R. M. P.; 4. Left mento-posterior, L. M. P. The 
breech presentations are : 1. Left sacro-anterior, L. S. A. ; 2. 
Right sacro-anterior, R. S. A. ; 3. Right sacro-posterior, 
R. S. P. ; 4. Left sacro-posterior, L. S. P. 

Give the causes of cephalic presentations, and state why 
vertex presentations are favorable. 

The causes of cephalic presentation are: 1. The peculiar 
shape of the uterus and of the fetal ellipse, the smaller ex- 
tremity of the fetal ellipse accommodating itself to the smaller 
portion of the uterine cavity; 2. The fetal center of gravity 
lies near the head, which becomes the dependent portion. 



OBSTETRICS AND GYNECOLOGY. 211 

How would you know a head=presentation? How a 
breech presentation? How a transverse presentation? 

In cephalic presentations palpation externally reveals the 
hard fetal skull at the superior strait; vaginal examination 
will reveal the dome-like projection of the brow or the vertex, 
or the features of the face. In breech presentations, if the 
membranes have broken, there will be a discharge of meco- 
nium; palpation will also show the soft pelvic structures, 
while externally the head can be felt at the upper portion of 
the abdominal wall. In transverse presentation the long axis 
of the fetus lies at right angles to the long axis of the maternal 
body; vaginal examination is liable to show an arm or elbow 
presenting. 

Describe the mechanism of expulsion in natural labor. 

Expulsion is accomplished by the direct action of the 
uterine muscles upon the fetal body. The fetus is expelled 
because there is a decided diminution in the intrauterine 
space, and the intrauterine contents are propelled in the 
direction of least resistance, down the lower canal. 

What is the " bag of waters," its functions and manage= 
ment during labor? 

The bag of waters is the tough elastic membrane containing 
the liquor amnii, which can be felt protruding through the 
os during the process of dilatation. Its function in labor is 
to distend the cervical fibers, which it does by hydraulic pres- 
sure. It should never be ruptured in primiparous women, 
and in multipara? only after full dilatation of the os has been 
accomplished. 

State the causes of dilatation of the os and cervix uteri 
as related to labor. 

There are two causes of cervical dilatation in labor, namely, 
the wedge-like action of the bag of waters acting on the 
edematous cervical tissues, and the upward traction exerted 
by the longitudinal layer of muscular fibers in the uterine 
walls. 



212 OBSTETRICS AND GYNECOLOGY. 

Give a brief description of the three stages of labor. 

During the first stage of labor the pains occur at intervals 
of 30 to 5 minutes; they accomplish during this time the 
dilatation of the os. This stage may take from 2 to 20 hours, 
and the patient for most of this time may remain out of bed. 
In the second or expulsive stage, the patient lying in bed, the 
pains occur every % to 5 minutes, and are assisted by volun- 
tary bearing-down on the part of the patient. This drives 
the presentation down upon the perineum, which bulges, and 
by its resistance directs the presentation to the vulvar orifice, 
through which it finally emerges. This stage consumes from 
30 minutes to 2 hours. The third stage, which seldom lasts 
over half an hour, consists in the expulsion of the placenta 
and membranes. 

What may cause premature rupture of the membranes? 
How may this rupture influence the progress and conduct 
of labor? 

Undue tenuity of the membranes may cause rupture to 
occur with the first labor pains. They may also be ruptured 
by the careless introduction of the finger during a pain. 
When the water escapes early the labor is said to be "dry." 
This results in slow progress of the presenting part, and in 
tedious dilatation of the os. The cervix is liable to extensive 
lacerations in such cases. 

Give the management of the second stage of labor. 

The patient lies upon the side toward which the fetal back 
is directed. In multiparas, if the membranes fail to rupture 
after full dilatation of the os, the obstetrician may break 
them with the finger-nail during the interval between two 
pains ; the water should be allowed to escape slowly. As the 
head descends to the floor the perineum must be guarded 
from laceration; on delivery of the head it should be sup- 
ported until the shoulders emerge, and as the child descends 
the hand should be placed upon the fundus uteri to maintain 
good contraction of the uterine muscle. 



OBSTETRICS AND GYNECOLOGY. 213 

Define the third stage of labor, and state how it should 
be managed. 

This is the period of placental expulsion. Immediately- 
after the birth of the child the uterus contracts and the pla- 
centa sinks to the lower uterine segment. Here it lies for 15 
to 30 minutes, when a strong contraction occurs and the pla- 
centa is expelled. The accoucheur may, after ligation of the 
cord, hasten this delivery of the secundines by the applica- 
tion of Crede's method. If hemorrhage occur or the uterus 
fail to contract, fluid extract of ergot may be administered, 
and a firm pad and binder should be applied. 

Describe the delivery of the placenta after the method 
of Crede. 

This consists in applying gentle rotatory friction to the 
fundus uteri until it is felt to harden under the influence of 
a uterine contraction ; the fundus is then grasped by the hand 
and compressed, while at the same time pressure is made 
downward and backward in the line of the axis of the par- 
turient canal. The placenta is rapidly expelled by this 
process. 

Describe the preparation of the bed, the woman, the 
physician and the nurse for a case of labor. 

The bed-linen should be clean, and on the side on which 
the woman lies the special temporary coverings should be 
laid. These include a large pad, a clean sheet, and a rubber 
blanket. These are removed after delivery is accomplished. 
The woman, as soon as labor begins, is given a full bath, and 
the external genitalia are cleansed with green soap and alco- 
hol. A clean garment is worn, and this is rolled up above 
the hips to prevent soiling. She is covered with a clean sheet. 
The physician and nurse disinfect themselves according to 
the accepted methods of aseptic surgery. 

Give the causes of separation of the placenta. State 
how the placenta normally presents at the os uteri. De= 
scribe the treatment. 

It is probable that the main cause of placental separation 



214 OBSTETRICS AND GYNECOLOGY. 

is a diminution in the area of placental attachment due to the 
excessive uterine contraction. Another view is that there 
occurs a partial central detachment of the placenta, with sub- 
sequent retroplacental hemorrhage. The separation does not 
occur until the beginning of the third stage of labor. The 
placenta once separated is expelled to the os uteri by passing 
through and inverting the membranes which drag after it; 
the body of the placenta bulges forward in a spherical form. 
Duncan's theory is that the placenta slides down the lower 
uterine segment edgewise. The treatment of placental sepa- 
ration is expulsion by Crede 's manipulation. 

What is the management of retained placenta? 

Retained placenta is quite distinct from adherent placenta. 
The former means a resting of the detached placenta in the 
temporarily paralyzed lower uterine segment. It is a harm- 
less condition, and is treated by Crede 's expression. Adhe- 
rent placenta is one that is partially detached, but remains 
adherent at points to the original site of placental attach- 
ment. It causes post-partum hemorrhage, and requires imme- 
diate manual extraction. 

How should the first examination be made at the bed* 
side of a woman in labor? 

The object of the examination is to determine the position 
and presentation of the child, its condition, the progress of 
the labor, the size of the maternal pelvis and the condition 
of the soft structures of the parturient canaL The abdomen 
is first palpated and ausculted, the patient lying on her back. 
A vaginal examination is then made with the patient in the 
left lateral recumbent posture. The finger is retained against 
the membranes until the patient has had a pain in order that 
the efficiency of the pains may be determined. 

What is the perineum? How is it endangered in labor, 
and how should it be protected? 

The perineum is the pelvic floor, composed mainly of mus- 
cles and fibrous tissues. The main muscle is the levator ani, 



OBSTETRICS AND GYNECOLOGY. 215 

a large butterfly-shaped muscle, which affords the chief sup- 
port to the pelvic viscera. As the head descends it impinges 
on the perineum and stretches it; not infrequently serious 
lacerations result in consequence of too precipitate delivery, 
disproportion between the head and vulvar orifice, or imper- 
fections in the mechanism of labor. There are various means 
of protecting the floor in labor. The head may be retarded 
by Hold's method, which consists in pressing the thumb 
against the occiput above and the index acd middle fingers 
posteriorly against that portion of the head nearest the four- 
chet. The forceps may be applied and the movement of the 
head controlled. Bit gen's method of elevating the head and 
Olshausen's method of rectal expression are both valuable. 

What is episiotomy, and when is such interference indi=> 
cated? 

Episiotomy is the making of a lateral incision of the vulva 
for the purpose of relieving vulvar and perineal tension. 
The incisions are made during the height of a pain upon the 
mucosa just within the vulvar cleft, and are from % to % 
inch long and 14 inch deep. The operation should not be 
performed, simple perineal laceration being preferable. 

How should laceration of the perineum occurring during 
labor be treated? 

By immediate suturation if the tear be over y 2 inch long. 
Simple tears of the fourchet do not require suturing. Inter- 
nal tears of the sulci and tears involving the sphincter require 
immedate repair. If the tear is a simple median tear, and 
the tissues are severely bruised, a primary perineorrhaphy 
may not prove successful. 

Give the causes and treatment of laceration of the cer= 
vix uteri. 

Abortion or miscarriage when the cervix is still rigid; pre- 
cipitate delivery, especially if the woman be on her feet; 
oversize of the fetal parts; instrumental delivery, the head 



216 OBSTETRICS AND GYNECOLOGY. 

not yet having escaped from the uterus. If there is no hem- 
orrhage from the tear nothing should be done. If the circular 
artery has been cut a suture must be introduced at once. 

Give the rules for administering anesthetics in labor, 
stating when they are indicated. 

No anesthetic is required in a normal labor until the head 
is down on the perineum ; it is then well, if the pains be severe 
and the patient suffering unduly, to administer a few drops 
of ether or chloroform, not sufficient to arrest the uterine 
contraction, but enough to dull the pain. In all operative 
procedures full anesthesia will be required. In puerperal 
eclampsia during the convulsions chloroform should be ad- 
ministered ; also in the spasms of major chorea. 

State the effects of anesthetics on the os uteri," cervix 
uteri, abdominal muscles, perineum and child. 

If the anesthesia be complete the cervix, os and perineum 
become relaxed ; all voluntary motion ceases, and the rigidity 
of the parts is overcome. A certain amount of fetal asphyxia 
results in profound maternal anesthesia. The labor is neces- 
sarily protracted, since the uterine contractions are largely 
or completely abolished. 

What are the antiseptic measures to be employed in the 
care of a case of labor? Define the terms asepsis and 
antisepsis, and give their proper application in the lying=in 
chamber. 

Asepsis means absence of septic matter, or freedom from 
infection. Antisepsis means exclusion of the germs that 
cause putrefaction or infection. As applied to labor it means 
the thorough cleanliness of the patient, bed, room, water, 
instruments, dressings, clothing, physician and nurse. It 
includes the use of antiseptic agents, such as carbolic acid, 
mercuric chlorid, creolin, lysol and the like. It includes for 
some the use of rubber gloves and the exclusion, as far as 
possible, of the vaginal examination. 



OBSTETRICS AND GYNECOLOGY. 217 

What would contraindicate the use of anesthetics in 
labor? 

Grave renal disease and any severe pulmonary affection. 

What preliminary preparations are necessary for the 
safe conduct of labor? 

The nurse should have on hand aseptic dressings, anti- 
septic agents, sterile water, hemostatic remedies, as gauze, 
ergotin and hot water, bichlorid tablets, creolin or lysol, chlo- 
roform to meet an eclamptic seizure, obstetric forceps, and 
whatever else may be needed to meet any emergency. 

What are the dangers to the mother during the second 
stage of labor, and how can they be minimized? 

The dangers are uterine inertia, with prolonged pressure 
of the fetal head upon the maternal tissues, which might 
result in a slough; the onset of eclampsia; rupture of the 
uterus from obstruction; laceration of the cervix and peri- 
neum from disproportion between the head asd vulvar orifice, 
or from precipitate labor; hemorrhage from premature sepa- 
ration of the placenta; apoplexy or syncope; rupture of 
varicose veins. 

What are the uses and dangers of ergot in obstetric 
practice? 

The routine administration of ergot is to be condemned. 
It should be employed in uterine exhaustion and inertia dur- 
ing the late second and third stages of labor and after delivery 
has been completed. If given too early it may cause an 
irregular hour-glass contraction of the uterus, with retention 
of placenta, clots, membranes or debris. It has a retarding 
influence upon the development of the milk. It may, if given 
early, cause fetal asphyxia from tetanic uterine contraction. 
It also increases the danger of cervical and perineal lacer- 
ations. 

State under what circumstances the vaginal douche may 
be employed before, during, and after labor. Give the 
technic. 

Unless the patient be already infected, as from gonorrhea, 



218 OBSTETRICS AND GYNECOLOGY. 

a vaginal douche should not be given before labor, in order 
to avoid introduction of germs with the nozzle of the syringe 
and the washing away of the normal vaginal secretion. Dur- 
ing labor a douche is given only when there is a profuse 
gonorrheal discharge or when some obstetric operation is 
about to be performed. After normal labor no douche is 
required as a rule. If there has been much manipulation of 
the parts, or version or other operation has been performed, 
one douche should be given, mercuric chlorid 1-2000 being 
employed. If the lochia become offensive at any time vaginal 
douching should be begun at once. 

Describe the duties of the accoucheur during normal 
labor. 

He is to act simply as an overseer. Examination should 
not be made too freely; only often enough to note a satisfac- 
tory progress of the labor. During the second stage he should 
regulate the descent of the head, institute measures to pre- 
serve the perineum, support the head after delivery until the 
shoulders are born, attend to the mouth and eyes of the child, 
ligate the cord, and superintend the discharge of the secun- 
dines. He should see that uterine relaxation does not occur, 
and after the patient has been cleaned he should apply the- 
pad and binder. He should see that the proper toilet for 
the baby is made. 

What care does the mother require after labor? 

She should be covered to prevent chilling and shock. She- 
should be cleaned as soon as possible, and the proper occlu- 
sive dressing of the vulva applied and secured to the abdom- 
inal binder. The bed should be made, and clean clothing for 
it and the patient be provided. If there is a tendency to- 
relaxation of the uterus ergot should be administered. The 
head should be kept low and visitors excluded. The visits 
should be made at suitable intervals, and careful watch kept 
of the pulse, temperature, discharge and breasts. The pro- 
gress of involution should be noted. The bowels should be- 
opened by the third day and the proper diet instituted. 



OBSTETRICS AND GYNECOLOGY. 219 

What is involution? Define subinvolution. How long 
a time is usually required for involution, how may it be 
promoted, and what causes may operate to delay or pre= 
vent it? 

By involution, as applied to the uterus, is meant the retro- 
gressive change undergone by that organ after parturition, 
by which it returns to its normal weight and condition. It 
is brought about mainly by a rapid fatty degeneration of the 
hypertrophied muscular tissue. It is completed in six weeks, 
and is favored by rest in bed, the repair of cervical and peri- 
neal lacerations, the prevention of uterine displacements, and 
the nursing of the child. It is delayed by early rising, 
bottle-feeding of the baby, neglect of the cervix, uterus and 
perineum, and an early resumption of household duties. 
Subinvolution is a failure of the uterus to return to its normal 
size. 

What are after=pains? State their cause and give the 
treatment. 

After-pains are irregular and painful contractions of the 
uterus produced by efforts on the part of that organ to expel 
clots or shreds of membrane; they indicate a partial relaxa- 
tion of the uterine tissue, and are more common in multiparas. 
They are relieved by pressure, and are followed by the dis- 
charge of clots. The treatment consists in the administration 
of opiates and fluid extract of ergot, embrocations of chloro- 
form and belladonna liniments or a hypodermic injection of 
morphin. 

What general directions should be observed in passing 
the catheter on a patient during the puerperal state? 

Absolute cleanliness of the meatus and vestibule, as well as 
of the catheter, to prevent cystitis. The parts should be 
bathed in mercuric chlorid 1-5000, and the patient should 
not be catheterized oftener than once in eight hours. 

What changes occur in the feta2 circulation at birth? 

With the stopping of the feto-placental circulation there 



220 OBSTETRICS AND GYNECOLOGY. 

occurs a closure of the foramen ovale, the Eustachian valve 
atrophies, and the ductus venosus and ductus arteriosus close 
and atrophy; the pulmonary circulation increases at once 
and becomes as in the adult individual. 

What indications of premature birth can be determined 
in the infant? 

Under size of the infant; the nails do not project over the 
finger-ends ; there may be some lanugo present, and there is 
an excess of vernix caseosa; the face is senile and wrinkled, 
and the development of the limbs imperfect; there is a ten- 
dency to subnormal temperature. 

How soon after the birth of the child should the um= 
bilical cord be ligated, and describe your method of pro= 
cedure? How should the umbilicus be managed? 

The cord should be ligated only after the pulsations have 
entirely ceased. A small-sized tape should be used, and the 
cord tied about 2 inches from the umbilicus, a surgeon's knot 
being used. It may be necessary in very thick cords to 
"strip" the cord so as to remove the excess of Wharton's 
jelly. The stump and umbilicus should be thickly dusted 
with a powder of salicylic acid 1 part and starch 4 parts, and 
then covered with salicylated cotton, through which the cord 
is passed. The whole is then supported by the binder. 

Describe the care of the infant during the first 24 hours 
after birth. 

After the establishment of respiration and the severing 
of the cord the baby should be given a bath. The vernix 
caseosa must be removed by rubbing with sweet oil. Castile 
soap and warm water are used in cleansing, and care must 
be taken not to irritate the delicate skin by rubbing. Diapers 
must be changed hourly, and plenty of talcum powder dusted 
on the body to prevent chafing. The breast should be given 
the baby every four hours. In this way it learns to nurse, 
consumes the colostrum, whereby the meconium will be ex- 
pelled, and by reflex action causes firmer uterine contraction. 



OBSTETRICS AND GYNECOLOGY. 221 

Describe the immediate care of the new=born child when 
for any reason the mother cannot nurse it. Give the rules 
for artificial feeding. 

The new-born baby does not need food for the first 24-36 
hours. It may be given a spoonful of water now and then, 
and if it seems hungry it may be given two or three spoonfuls 
of a mixture of condensed milk and water 1 part to 12. If 
it become necessary to feed the baby from the bottle the latter 
must be kept absolutely clean, and a milk-preparation of 
suitable strength should be given. Germs may be destroyed 
by Pasteurization. The preparation usually employed con- 
sists of condensed milk 1 part, boiled water 12 parts, cream 1 
part, and limewater 1 part. The baby should be fed every 2 
to 2y 2 hours during the first month. The nursing should 
consume from 15 to 20 minutes. 

What instructions should be given a primipara in re= 
gard to lactation? 

She should be instructed as to the frequency of nursing 
and care of the nipple. Every 2 to 2y 2 hours by the clock is 
often enough for the feedings, and after the nursing the nip- 
ple should be bathed with warm water, thoroughly dried with 
a soft towel or lint, and anointed with sweet oil. The oil 
should be removed before the nipple is given to the infant 
at the next feeding. 

How soon after parturition should a woman menstruate? 

If she nurse her baby menstruation does not normally 
return until the ninth month. An early appearance of the 
menstrual flow usually indicates subinvolution of the uterus 
or cervical laceration. 

What is the puerperal state? 

The puerperal state or puerperium is the period following 
the delivery of the placenta, in which the processes of involu- 
tion are being carried on. It is characterized by rapid dimin- 
ution in the size of the uterus and vagina, decrease in the 
pelvic circulation, and lessening in the quantity of blood 
circulating in the body. 



222 OBSTETRICS AND GYNECOLOGY. 

What are the most frequent complications of the puer= 
peral period? 

Infection of the birth-canal, subinvolution, inflammation 
and abscess of the mammary gland, postpartum hemorrhage 
and constipation. 

How should a case of labor be conducted to avoid puer= 
peral infection? What are the sources of septic infection 
in the puerperal state, and what would be the proper man* 
agement if infection should occur? 

Thorough asepsis of the woman, bed, surroundings, physi- 
cian and nurse, as already delineated, must be insisted upon. 
The hands of the physician and nurse, the water employed, 
and the instruments are the chief sources of danger. Should 
infection occur the vagina and uterus should be well douched 
with mercuric chlorid 1-2000-4000, and the uterus curetted 
with a dull curet to remove decaying fragments of placenta 
and membranes. This will generally be sufficient for local 
treatment. Internally, quinin, stimulants and strychnin 
must be administered. The graver forms of puerperal sep- 
sis require special courses of treatment. 

Describe the proper method of delivering an adherent 
placenta at term. 

The hand, which should be aseptic, must be immediately 
introduced into the uterine cavity to the fundus, following 
the umbilical cord to the placental site. The placenta should 
be grasped and the adherent portions pinched off rapidly. 
The external hand grasps the uterine fundus and the internal 
hand is expelled by the uterine contractions. A hot douche, 
intrauterine, must then be given, and ergot administered by 
the mouth or hypodermically. Firm uterine contractions 
must be secured before the patient is left. 

How would you treat asphyxia in the new=born child? 
What are its causes and symptoms? 

The causes of asphyxia neonatorum are syphilitic stenosis 
of the vessels of the cord and placenta, abnormality of the 



OBSTETRICS AND GYNECOLOGY. 223 

heart or great vessels, early separation of the placenta, nndue 
pressure upon the cord, sudden maternal death, renal inade- 
quacy, and grave maternal lung-disease. The condition 
appears in two forms, viz., asphyxia livida and asphyxia 
pallida. In the former the baby is blue or livid, there are 
irregular gasping efforts, the heart-beats are strong, and the 
reflexes are preserved. In the pale variety respiration is 
altogether abolished, the surface is pale, the heart-sounds are 
weak and irregular, and the reflexes are absent. The treat- 
ment consists in early ligation of the cord, suspension of the 
child by the feet, cleansing of the throat and mouth by the 
finger, slapping the back and buttocks, the pouring of water 
or ether on the epigastrium, and in the pronounced cases the 
-employment of some form of artificial respiration, notably 
the methods of Dew, Laborde, Schultze arid Prochownick. 
Occasionally mouth-to-mouth insufflation, catheterization of 
the larynx, or tracheotomy may be required. 

Describe a method of resuscitation of the new=born. 

Dew's method is excellent. The infant is grasped in the 
left hand in such a manner that the neck rests between the 
thumb and forefinger and the head hangs over in the position 
of full extension; the upper portion of the back rests in the 
palm of the hand, while the remaining fingers are inserted 
into the left axilla. The knees are grasped by the right hand, 
the right knee resting between the thumb and forefinger, the 
left knee between the index and middle fingers, and the thighs 
in the palm of the hand. The right hand depresses the body 
to favor inspiraton, while to secure expiration the movement 
is reversed and the child doubled upon itself. 

What are the results of subinvolution of the uterus, and 
-what is its treatment? 

Subinvolution of the uterus, if not corrected, results in a 
chronic endometritis, retrodisplacement and subsequent pro- 
lapse of the uterus from increased specific gravity, and the 
development of a chronic invalidism. The treatment consists 
in the retention of the uterus in its normal position by means 



224 OBSTETRICS AND GYNECOLOGY. 

of a pessary, curettage of the uterus, suturation of all cer- 
vical and perineal lacerations, and the administration of 
tonics, ergot and thyroid extract. 

How would you recognize retention of urine during 
labor and how after labor? Minutely describe the treat= 
ment that should be employed in each case. 

Retention of urine during labor is exceedingly uncommon. 
It might result from an uncorrected retrodisplacement of the 
uterus that has gone on to sacculation. In such a case, if 
catheterization of the bladder by the prostatic catheter fails, 
suprapubic puncture of the bladder would be required. Re- 
tention of urine after labor is not uncommon. It is charac- 
terized by inability on the part of the patient to urinate, 
severe pain in the bladder, and the development of a cystic 
tumor over the symphysis, which presents dulness on percus- 
sion. The treatment consists in aseptic catheterization, with 
withdrawal of one-half to three-fourths of the vesical con- 
tents, in order to avoid syncope. 

Describe the technic of intrauterine irrigation, and state 
when its employment is justifiable. 

Intrauterine irrigation is required only after some intra- 
uterine manipulation, as the performance of version, manual 
extraction of the placenta, or high forceps application, or in 
case puerperal sepsis has developed. The teehnic consists in 
antiseptic douching of the vagina and vulva, followed by the 
introduction to the uterine fundus of the two-way catheter. 
Mercuric chlorid 1-4000, creolin, lysol or sterile water may 
be employed. The douching may be resorted to once, twice 
or three times daily, according to the gravity of the patient's 
condition. 

Mention the pathogenic bacteria that invade the vagina, 
and state how the vagina is normally protected from them. 

A number of pathogenic germs have been discovered in the 
vagina. The most common are the streptococcus pyogenes, 
staphylococcus pyogenes aureus, staphylococcus pyogenes al- 



OBSTETRICS AND GYNECOLOGY. 225 

bus, bacterium coli commune, bacillus pyocyaneus, bacillus 
pyogenes fcetidus and others. There normally exist in the 
vagina a large number of long rod bacilli known as Doder- 
lein's bacilli. These secrete an acid environment which de- 
stroys pathogenic germs. 

Define puerperal sepsis, and state how to prevent it and 
how to overcome it. What is autoinfection? 

Puerperal sepsis is the infection of the puerperal woman 
by pathogenic germs. It may be prevented by careful atten- 
tion to the laws of asepsis and antisepsis. If septic infection 
develop it should be combatted in the manner already de- 
scribed. Autoinfection of the puerperal woman is a rare 
form of sepsis, in which the germs are already in her system 
before the onset of labor, and become active immediately 
after parturition. 

State the causes, pathology, symptoms, treatment and 
sequelae of puerperal phlebitis. 

Puerperal phlebitis is a rare form of puerperal sepsis 
originating in the sinuses of the uterus. The germs invade 
the clots in the mouths of the sinuses; these quickly liquefy, 
and give rise to hemorrhages and to emboli, Avhich are carried 
to remote portions of the body. This may result in instant 
death or in pyemia, with septic pneumonia, paralysis and 
other serious consequences. The treatment consists in the 
general treatment of puerperal sepsis, with avoidance of all 
local interference other than the introduction of a gauze tam- 
pon to control the hemorrhage. 

How would you diagnose puerperal metritis, and what 
methods would you employ in its treatment? 

Puerperal metritis is a late septic inflammation of the 
uterine muscle. It is characterized by an offensive lochial 
discharge, which contains fragments of necrotic tissue and 
detached portions of muscular fibers that have sloughed from 
the uterine wall. The uterus is large, soft, boggy and sensi- 
tive. There is danger of perforation of the uterine walls and 
15 



226 OBSTETRICS AND GYNECOLOGY. 

the development of general peritonitis. Uterine phlebitis 
may also develop, with a resulting general pyemia. The 
treatment consists in hysterectomy performed with thorough 
asepsis. 

Define hysterectomy, and state when it is applicable in 
obstetric complications. 

Hysterectomy is excision of the uterus. It is indicated in 
puerperal metritis, extensive involvement of the broad liga- 
ments, and when tubal and ovarian infection is associated 
with profuse hemorrhage from the uterus. 

What is phlegmasia alba dolens? Give the varieties, 
symptoms and treatment. 

Phlegmasia alba dolens or "milk leg" is a peculiar late 
manifestation of puerperal sepsis, in which there occurs a 
thrombosis of the iliac or femoral veins on one side, usually 
the left, with an immense edema of the affected limb, which 
presents a characteristic white or milky appearance. In the 
phlebitic or thrombotic form the edema first appears below 
at the ankle, the disease occurring as a sequel of uterine 
phlebitis, coagula being carried from the placental site into 
the hypogastric veins. In the cellulitic form the disease 
occurs as a result of a direct extension of an inflammatory 
process from the uterus through the broad ligament and pelvic 
cellular tissue, the exudate occluding the iliac veins. The 
symptoms are pain in the affected limb along the course of 
the femoral vein, rapid pulse, elevation of temperature, cramp- 
like pains in the calf, edema, and extreme pallor of the limb, 
or, in a certain proportion of the cases, bluing of the leg; 
abscess or gangrene may follow. The treatment consists in 
the administration of stimulants and tonics, disinfection of 
the birth-canal, gentle laxatives, and immobilization of the 
limb, which should be elevated and kept warm. Anodyne 
poultices, and later ichthyol and belladonna ointments, may 
be applied. Abscesses should be opened, and if gangrene 
occurs amputation is necessary. 



OBSTETRICS AND GYNECOLOGY. 227 

What is postpartum hemorrhage? State the causes and 
varieties, and give the treatment, including prophylaxis. 

Postpartum hemorrhage or "flooding" is hemorrhage occur- 
ring at any time during the 24 hours after parturition. It 
may be primary, at the time of delivery, or secondary, when 
it occurs after contraction of the uterus has been secured. 
Its causes are retention of placental debris, adherent pla- 
centa, uterine inertia, or severe laceration of the lower birth- 
canal. The symptoms are free escape of blood, pallor, run- 
ning pulse, restlessness and coma. The prophylactic treatment 
includes the use of strychnin and tonics during the last 
trimester of pregnancy, and at the time of labor the avoidance 
of extreme exhaustion, and if the uterus be atonic the admin- 
istration of a dram of ergot as soon as the head is born. The 
active treatment consists in the immediate removal of all clots 
and debris, the application of Crede 's manipulation, the 
hypodermic injection of ergot or ergo tin, the intrauterine 
injection of hot water, or the introduction of a large tampon 
of iodoform or sterile gauze. Herman's method of continual 
manual compression of the uterus and compression of the 
abdominal aorta may be tried in extreme cases. Traction on 
the cervix with volsellum-forceps will often control the bleed- 
ing. Bleeding from the lower birth-canal must be controlled 
by the introduction of sutures. 

What is a tampon? How is it made and when is it 
properly used? What precautions are to be observed in 
its use? 

A tampon is a plug of cotton, gauze, wool or oakum used 
to stop some canal or compress a bleeding surface. It may 
he made by passing a string around a portion of the substance 
used, or it may consist of a long strip of material packed 
in firmly. It is indicated in obstetrics in excessive hemor- 
rhage, as from placenta prasvia, relaxation of the uterus, or 
lacerations of the lower birth-canal. Care must be taken to 
see that the material used is thoroughly aseptic, and that the 
cervix and vagina are not so distended as to give entrance to 
air, wherebv air-embolism mav be induced. 



228 OBSTETRICS AND GYNECOLOGY. 

Differentiate eutocia and dystocia. Mention important 
varieties of the latter. 

Eutocia is normal or easy labor ; dystocia is abnormal, diffi- 
cult or painful labor. Dystocia may consist in precipitate, 
retarded or obstructed labor, or labor complicated by fetal 
or maternal accidents, or by gross fetal or maternal disease. 
This includes hydrocephalus, malpositions and malpresenta- 
tions of the fetus, eclampsia, rupture of the uterus, prolapse 
of the cord, placenta prsevia, premature separation of the 
placenta, contracted pelvis, and various other conditions on 
the part of the fetus and mother. 

Give the causes of dystocia in the uterus, vagina, pelvis, 
and vulva. 

In the uterus as causes of dystocia may be mentioned the 
presence of tumors, double uterus, abnormal placental attach- 
ment, rupture of the uterus, and malpresentations of the 
fetus. In the vagina, septa, stenosis, and tumors; in the 
pelvis the various forms of contraction and bony and carti- 
laginous tumors ; in the vulva, hematomata, stenosis or atresia, 
imperforate hymen and tumors. 

Describe the difficulties which arise during labor from 
malposition of the fetal head. 

If the head lie transversely in the superior strait it will 
become partially extended, and cause larger diameters of the 
fetal skull to engage than in vertex presentations. This will 
cause prolongation or absolute blocking of the labor. Exces- 
sive moulding and disfiguring of the fetal presentation will 
follow; forceps or version may be necessitated. If the face 
or brow present, labor may become impossible. 

How would you diagnose and manage a case of occipito= 
posterior presentation? 

In this case the vertex may be directed to the right or to 
the left sacro-iliac synchondrosis, and the sagittal suture will 
lie in the right or left oblique diameter respectively. The 
R. 0. P. is the most common of the occipito-posterior presen- 



OBSTETRICS AND GYNECOLOGY. 229 

tations. The case must be treated by laying the woman upon 
the side toward which the fetal back is directed in order to 
secure full flexion of the head, and thereby prevent backward 
rotation of the occiput. A firm binder should be applied, 
and quinin must be administered and delivery accomplished. 
As the head rotates anteriorly the instruments must be with- 
drawn and reapplied in the new oblique diameter. 

How would you diagnose and deliver an occiput in the 
hollow of the sacrum? 

In this case the small fontanel will be felt in the median 
line posteriorly and the large fontanel high up anteriorly. 
The ears may be palpated to either side in the transverse diam- 
eter. Labor will be blocked. Forceps must be applied, and 
as traction is made the handles must be elevated in order to 
overflex the head. When the occiput begins to greatly dis- 
tend the perineum and the brow comes under the symphysis, 
the handles must be carried downward, and the head delivered 
with the face emerging from under the symphysis. 

Describe in detail the proper procedure when the head 
is movable above the brim of the pelvis but does not 
engage. 

There is probably some degree of pelvic flattening present. 
If so the head will lie transversely. Axis-traction forceps 
should be applied and the head made to engage. If this be 
impossible, and the contraction of the pelvis is not too great, 
podalic version is indicated. In more extreme degrees of 
contraction Cesarean section must be performed. 

Give the frequency, causes, diagnosis, prognosis, treat- 
ment and dangers to the fetus in pelvic presentations. 

Pelvic presentations of the fetus occur in about 3 per cent, 
of all cases of labor. The causes of breech presentations are 
reserval of the shape of the fetus or of the uterine cavity, 
hydrocephalus, fibroid tumors of the uterus, prematurity of 
the fetus, hydramnios, fetal monstrosities, and multiple preg- 
nancy. In these cases the fetal head is freely movable and 



230 OBSTETRICS AND GYNECOLOGY. 

high up in the abdominal cavity; the fetal heart-sounds will 
be heard above the umbilicus and to either side. Vaginal 
examination shows an absence of a hard and protuberant pre- 
sentation; the presentation is high up, and the bag of waters 
long and finger-like. If the membranes have ruptured a dis- 
charge of meconium will be noted. The prognosis is serious 
for the fetus. Thirty per cent, of these babies perish from 
asphyxia or injury to the head and neck in delivery. The 
treatment consists in non-action until the birth of the umbili- 
cus ; then there must be speedy extraction of the after-coming 
head in order to avoid fetal death. 

Describe the management of an impacted breech pre= 
sentation. 

If the breech become impacted attempts may be made to 
decompose it by Goodell's method, viz., the dragging down of 
one leg, upon which traction is made. If this does not succeed 
axis-traction forceps may be applied over the pelvis; this is 
a very efficient method. Other methods consist in the use of 
a fillet around the waist and thighs, and in dead babies the 
blunt hook over one thigh. 

Give the frequency, causes, mechanism and treatment 
of face presentation, L. M. A. position. 

Face presentation occurs in about % per cent, of all cases 
of labor. It results from anything which will prevent 
thorough flexion of the head, such as an enlarged thyroid or 
thymus gland or a prominent thorax, or anything that will 
disturb the relationship existing between the long axes of the 
body and head of the fetus, as dolichocephalus. The mech- 
anism consists in full extension and moulding, descent of the 
chin to the pelvic floor, anterior rotation to the symphysis 
under which it lodges, and birth of the head by a process of 
flexion; the shoulder and hip then rotate from the opposite 
side, and the rest of the mechanism is the same as in vertex 
presentations. If the chin be anterior the labor will prob- 
ably be easy, since small diameters present. If the head 



OBSTETRICS AND GYNECOLOGY. 231 

sticks, forceps may be applied and the chin drawn down, after 
which labor will proceed. 

Give the diagnosis of face presentation before and after 
rupture of the membranes. 

Before rupture of the membranes the presentation will be 
noted as high ; there is an absence of the dome-like projection 
of other head presentations; the features of the face may be 
detected. After rupture of the membranes the examining 
finger can be introduced into the mouth, when, if the child 
be living, reflex closure of the gums will be noted. 

How may a face presentation be converted into a vertex 
presentation? 

If labor have not yet begun Schatz's method of cephalic 
version, performed by external manipulation alone, may be 
attempted. With one hand firm pressure is exerted against 
the anterior portion of the fetal neck, while counter-pressure 
is made with the opposite hand upon the occiput ; at the same 
time an assistant pushes the breech in the direction in which 
the face is looking ; the head is thus flexed upon the body and 
the vertex caused to present. If labor have already begun, 
and the os is dilating, Baudelocque's method of cephalic ver- 
sion, the "ratchet method," may be attempted under anes- 
thesia. One hand is placed against the face, and while the 
thumb pushes the chin upward the fingers hook over the occi- 
put and drag it down; an assistant at the same time carries 
the breech over to the side toward which the face is directed. 

What is the mechanism of a mento=posterior position, 
and what the complications? 

A persistent mento-posterior position is an absolutely im- 
possible labor, and therefore there is no mechanism. For 
labor to advance the chin must strike the pelvic floor. The 
lateral height of the pelvis is 3y 2 inches (9 cm.), Avhile the 
length of the fetal neck is only iy 2 inches. The posterior 
height of the pelvis is 5 inches (12% cm.). In order for the 
chin to reach the floor in these cases it would be necessary for 



232 OBSTETRICS AND GYNECOLOGY. 

the thorax and occiput (18% cm. or 7 inches) to enter the 
superior strait simultaneously. No diameter of this strait 
could accommodate such a bulk. The uterus becomes tetanic 
in action, the head and shoulders become impacted, the child 
perishes, and the mother is exposed to the danger of uterine 
rupture. 

How should forceps be applied in a case of face presen= 
tation? 

In the mento-occipital diameter, the chin being in apposition 
with the heel of the bladder ; the forceps should be used only 
as rotators in mento-posterior positions. 

How would you manage a brow presentation? 

A brow presentation is an absolutely impossible case of 
labor. The occipito-mental diameter of the fetal head, 13^2 
cm., attempts to engage, but can find no accommodation in 
the superior strait. The treatment consists in the perform- 
ance of cephalic version, bringing down the occiput and apply- 
ing forceps. If this be not possible, podalic version should 
be tried. In impacted cases with the child dead, craniotomy, 
with perforation through the bregma, becomes necessary. 

How would you treat a case of lateral presentation? 

Lateral presentations of the head, including the parietal 
eminence or the ear, should be treated by manual replace- 
ment, converting the presentation into a true vertex presen- 
tation. If this be impossible forceps may be applied or 
podalic version performed. 

Make a diagnosis of transverse presentation, and state 
how it should be managed. Give the frequency, causes, 
mechanism and management of such a case. 

A transverse, shoulder or trunk presentation occurs in about 
i/ 2 per cent, of all cases of labor. The causes are oversize of 
the fetal head, overgrowth of the entire fetus, fetal mon- 
strosities, mobility of the fetus, hydramnios, multiple preg- 
nr.ncy, uterine deformities, undue obliquity of the uterus, 
uterine and pelvic tumors, placenta praevia, and traumatism, 



OBSTETRICS AND GYNECOLOGY. 233 

such as falls or jars. There is no mechanism for such a case, 
the labor being absolutely impossible. The condition may be 
recognized readily by external palpation, the child lying at 
right angles to the long axis of the maternal body. Vaginal 
examination reveals a high position of the presentation, and 
the shoulder or elbow may be palpated through the mem- 
branes. There is but one thing to do in all transverse pre- 
sentations, namely, podalic version under full anesthesia. 

How should a hand presentation be managed? What 
course would you pursue if you found an arm projecting 
from the vulvar orifice? 

This would indicate a cross-birth. The arm should be left 
alone, and podalic version performed. A tape may be tied 
around the wrist in order to prevent extension of the extremity 
during the process of turning; if the tape be held taut the 
arm is carried in front of the face and descends with the 
shoulders. 

What are the causes of precipitate labor, what are its 
dangers, and what is the treatment? 

Precipitate labor may be caused by an excess in the expul- 
sive power of labor or a deficiency in the resistant powers. 
The dangers to the fetus are asphyxiation from rupture of 
the cord or premature detachment of the placenta and injury 
from a fall upon the floor or into a commode. The maternal 
dangers are hemorrhage, fatal syncope from sudden evacua- 
tion of the uterine contents, inversion of the uterus, laceration 
of the cervix or perineum, and post-par turn hemorrhage. The 
treatment of precipitate labor consists in a retardation of the 
advancing presentation in order to avoid the foregoing acci- 
dents. When the head is on the floor short forceps may be 
applied and the progress of the head arrested. 

What are the causes of delay in labor (a) on the part of 
the mother; (b) on the part of the child? 

The maternal causes of delayed labor are uterine inertia 
and obstruction in the birth-canal from any cause. The fetal 



234 OBSTETRICS AND GYNECOLOGY. 

causes are malposition and malpresentation, oversize, hydro- 
cephalus, fetal syphilis, fetal ascites, and other diseases caus- 
ing overgrowth of organs or distention of cavities. 

State the dangers and symptoms of a prolonged labor. 

The symptoms of prolonged labor are those of uterine iner- 
tia (see below). The dangers are for the fetus fatal com- 
pression of the brain- centers and intrauterine respiration, 
with inspiration of liquor amnii or other substances. The 
maternal dangers are pressure-necrosis, the development of 
sepsis, exhaustion and death, and post-partum hemorrhage. 

Give the causes, diagnosis and management of uterine 
inertia. 

Uterine inertia is that condition in which the uterine con- 
tractions are irregular, weak and ineffectual, not sufficing to 
induce dilatation of the os or expulsion of the fetus. The 
causes are idiosyncrasy, advanced age of the woman, multi- 
parity, emotion, temporary paralysis of the uterine muscles, 
as from over-distension, weakness of the muscle, and any cause 
preventing the hydraulic action of the liquor amnii. The 
symptoms are weak, infrequent and irregular contractions, 
slight suffering, and slow or no advance of the fetal presen- 
tation. In the first stage of labor quinin may be adminis- 
tered in large doses and a firm abdominal binder applied; 
strychnin during the last weeks of pregnancy has a tendency 
to increase the efficiency of the uterine contraction. In the 
second stage of labor forceps should be applied, and ergot 
must be used after the delivery of the child in large doses to 
prevent post-partum hemorrhage. 

What is the proper management of rigidity of the os 
uteri in labor? 

Rigidity of the cervix is common in elderly primiparae and 
in those suffering from uterine inertia; it may result from 
cicatrices and from cancerous involvement of the cervix. The 
treatment consists in the administration of large doses of 
chloral, hot vaginal douches, anesthesia, cocain to the cervix r 
digital divulsion, or incision. 



OBSTETRICS AND GYNECOLOGY. 235 

Give the diagnosis and treatment of hour=glass contrac= 
tion of the uterus. 

Hour-glass contraction of the uterus is an irregular con- 
traction of the uterus, usually occurring before the escape of 
the placenta, which is retained above the ring of Bandl. The 
latter appears to be in an abnormal state of contraction. 
Digital exploration traces the cord up to the contracted ring. 
Treatment consists in digital divulsion of the contracted por- 
tion, followed by removal of the placenta, and antisepsis of 
the cavity. 

Give the causes, symptoms, diagnosis and prognosis of 
rupture of the uterus during labor, and state how such an 
accident should be managed. 

The exciting causes' of uterine rupture during labor are 
some insuperable obstruction to the delivery of the child, 
misdirected or injudicious efforts at version, and tetanic ac- 
tion of the muscle of the upper uterine segment from the 
administration of ergot. The predisposing causes are dimin- 
ished tonicity of the uterine walls, undue prolongation of 
labor, fatty degeneration of the uterine muscle, or a previous 
operation upon the uterus. The site of the rupture is usually 
in the lower uterine segment. The symptoms are sudden 
acute lancinating pain, immediate collapse, signs of internal 
hemorrhage, an anxious expression, pallor, rapid running 
pulse, recession of the presenting part, the presence of two 
distinct tumors, and the ability to detect the rent by the 
examining finger. The prognosis is grave; the maternal 
mortality is 55 to 60 per cent. The treatment consists in 
immediate evacuation of the uterine contents, and if the tear 
has not completely perforated the uterus the patient may be 
watched carefully for the development of sepsis. In com- 
plete laceration an abdominal section must be performed and 
the tear sutured aseptically. 

Make a differential diagnosis of intrauterine and extra* 
uterine hemorrhage. 

In the former there will be noted either a free escape of 



236 OBSTETRICS AND GYNECOLOGY. 

blood per vaginam or a rapidly distending uterine body, asso- 
ciated with the symptoms of hemorrhage. In the latter the 
signs of concealed hemorrhage will be present, and vaginal 
examination will reveal the presence of a boggy mass in the 
abdominal cavity and in Douglass' cul-de-sac. 

Give the diagnosis, causes and treatment of pelvic 
hematocele. 

Pelvic hematocele results generally from rupture of an 
extra-uterine pregnancy. It may result from rupture of 
varicose veins in the broad ligament. It is recognized by the 
signs of concealed hemorrhage and a rapidly increasing boggy 
mass in Douglas' cul-de-sac. The only treatment is abdom- 
inal section and ligation of the bleeding point. 

Name three important forms of hemorrhage occurring 
in obstetric practice. 

Antepartum hemorrhage, or that occurring in the last tri- 
mester of pregnancy. This may be due to placenta praevia 
or premature separation of the placenta. Intrapartum hem- 
orrhage is that occurring during the progress of labor, as in 
the case of uterine rupture or inversion of the uterus. Post- 
partum hemorrhage is that form occurring immediately after 
labor. 

What is placenta praevia? Name its causes, varieties, 
symptoms, dangers and management. 

Placenta previa is that condition in which the placenta is 
attached to the lower uterine segment, and presents in front 
of the fetus. It may be complete or central (placenta cen- 
tralis), lateral, marginal and parietal. The cause of placenta 
pragvia is unknown. It has been said to be due to uterine 
subinvolution, low fixation of the ovum, and downward 
growth of the decidua renexa. There is but one symptom, 
namely, free and painless hemorrhage, occurring at decreas- 
ing intervals and in increasing quantity. The dangers are 
fetal and maternal death from asphyxia, hemorrhage, air- 
embolism, and septic infection. The treatment consists in 



OBSTETRICS AND GYNECOLOGY. 237 

rapid dilatation of the os and delivery of the fetus by version, 
or in the marginal form the application of the forceps and 
rapid engagement of the head. In the central variety the 
hand must be carried directly through the placenta. 

Mention two distinct methods of dilatation of the cervix 
uteri in obstetric practice. 

Edgar's method consists in bimanual stretching and par- 
alyzing of the cervical muscle. The index and middle fingers 
of both hands are introduced into the cervix, which is gradu- 
ally but forcibly stretched in various directions. Another 
method is the use of bags, such as Barnes' or those of Cham- 
petier de Ribes. 

What are the dangers of traction on the child and on 
the placenta? 

Traction on the cord may cause premature separation of 
the placenta. It may cause rupture of the cord or avulsion 
of the cord from the placenta, or it may result in inversion 
of the uterus. 

What is inversion of the uterus, what are its causes and 
symptoms, and how is it recognized? 

By this term is meant a turning of the uterus inside out, 
either completely or in part. It may occur spontaneously, 
the uterine fundus or placental site being temporarily par- 
alyzed and sinking in; it may result from traction on the 
cord, the placenta not yet having separated ; or it may follow 
suction from close fitting of the detached placenta in the lower 
uterine segment and traction being made upon the cord. 
Other causes are vigorous Crede manipulations and violent 
bearing down on the part of the woman. The symptoms are 
acute pain, hemorrhage, shock, bearing down, and the appear- 
ance of a tumor in the vagina. This may be mistaken for a 
uterine polyp, but the surface of the latter will be covered 
with the normal uterine mucosa, while the inverted uterus 
will show decidual tissue and the site of the placental attach- 
ment ; the orifices of the Fallopian tubes may also be detected. 



238 OBSTETRICS AND GYNECOLOGY. 

The treatment of acute inversion consists in immediate re- 
placement, followed by the introduction of a strip of gauze 
to prevent recurrence. 

Give the causes, pathology, symptoms and prognosis of 
eclampsia gravidarum, and state the relative frequency 
in primiparae and multiparae. What is the treatment? 

Puerperal eclampsia or puerperal convulsion is a convul- 
sive or epileptiform seizure appearing suddenly in a woman 
prior to, during or shortly after labor, and characterized by 
tonic and then clonic convulsions of the muscles, with albu- 
minuria, coma and death. The great majority of cases occur 
in primiparae — about 75 per cent. Other causes are heredity, 
climatic influence, multiple pregnancy, extreme anemia, and 
nervous excitability, all acting as predisposing influences. 
The true cause is the presence in the blood of toxins, probably 
of hepatic origin, which cause a general arteriole contraction ; 
as a consequence there follows an anemia of the base of the 
brain and a corresponding cortical congestion. The symp- 
toms are fixing of the eyes, tonic contraction of the facial 
muscles (sardonic grin), lividity, rapid involvement of all 
the trunk muscles, distension of the superficial veins, and 
frothing at the mouth. The paroxysm lasts from % to 2 
minutes. It is followed by increasing coma and a rise of 
temperature. The urine becomes loaded with albumin. 
The prognosis is grave; 30 per cent, of the women and 50 to 
74 per cent, of the children perish. The causes of maternal 
death are asphyxia, cerebral apoplexy, syncope, pulmonary 
edema, and exhaustion. The fetus dies of asphyxia. The 
prophylactic treatment is the treatment of the kidney of preg- 
nancy. During the attack chloroform must be administered. 
After the spasm, if the patient be plethoric, venesection to 
the amount of 20-25 ounces may be performed, followed by 
the introduction of normal saline solution into the tissues. 
Croton oil 1 to 3 drops, chloral hydrate 30 grains by the rec- 
tum, and veratrum viride 15 drops of the fluid extract hypo- 
dermically may be administered. A hot pack aids in the 



OBSTETRICS AND GYNECOLOGY. 239 

elimination of the poison. The uterus should be emptied as 
soon as possible in order to still further relieve the system. 

Give the danger signals of impending eclampsia. 

Rapidly lessening amount of urates in the urine; lessened 
urinary toxicity, the development of eye-symptoms, including 
muscat volitantes, scintillations and blindness, and neuralgic 
pains over the eyes, under the clavicles and in the epigastrium. 

In case eclampsia gravidarum appears before the end of 
the eighth month how should it be managed? 

By dilatation of the os and removal of the child by forceps 
or version. The course of treatment already indicated should 
be adopted. 

What are the varieties of puerperal convulsions, and 
how are they differentially diagnosed? 

A puerperal woman may suffer from various convulsive 
seizures, including the true puerperal eclampsia. She may 
have an anemia or an hysteric convulsion, or one due to ner- 
vous irritability. A true epileptic convulsion may occur, 
but this is not accompanied by albuminuria, has not the same 
prodromata nor the rise of temperature, and there is, as a rule, 
a definite history of previous attacks. Meningitis is accom- 
panied by vomiting, optic neuritis, opisthotonos, and a rise of 
temperature before the onset of the convulsions. 

When is curettage of the uterus justifiable in obstetric 
practice, and how should it be performed? 

Curettage is required whenever there has occurred a reten- 
tion of some of the products of conception either after abor- 
tion or labor. The best curet is the finger of the obstetrician, 
but if this will not answer the dull curet may be employed 
or the placental forceps, under thorough asepsis and anti- 
sepsis. In curetting the uterine cavity the walls should be 
scraped systematically and without great pressure. The 
dangers are hemorrhage and perforation. 



240 OBSTETRICS AND GYNECOLOGY. 

Define puerperal mania. Give its etiology, symptoms 
and treatment. 

Puerperal mania is the most common form of puerperal 
insanity, or insanity occurring during the lying-in period. 
It may result from heredity, primiparity, anxiety, dystocia, 
and septic infection. Some authorities attribute all the cases 
to septic infection. The disease appears with alarming ab- 
ruptness. Without warning the patient becomes maniacal 
or wildly delirious, and suffers from the most peculiar hallu- 
cinations. A homicidal or suicidal tendency is common. 25 
to 35 per cent, of the cases die from exhaustion or from septi- 
cemia, or remain permanently insane. The patient should 
be confined in a hospital and given nerve-sedatives, bromids, 
hyoscin, trional, sulfonal and tonics. Rest and mental diver- 
sion are essential. 

What hygienic precautions are necessary for a nursing 
child if the mother has sore nipples? 

If the nipples are fissured the child may suck in blood and 
suffer from hematemesis. It should temporarily be fed on 
the bottle or from a spoon, but returned to the breast as soon 
as the nipple will permit. An artificial nipple may also be 
used. 

Give the management in a case of (a) flat or inverted 
nipples, and (b) cracked nipples. 

A flat or inverted nipple requires gentle traction and manip- 
ulation during the last weeks of pregnancy, or more powerful 
suction through a breast-pump. If this does not succeed an 
artificial nipple must be employed. Fissured nipples should 
be kept clean and dry, and anointed between the nursings 
with sweet oil. In worse cases healing applications are neces- 
sary, as ichthyol in lanolin or glycerin, or 1 dram each of 
bismuth subnitrate and castor oil, compound tincture of ben- 
zoin, or a 4 to 8 per cent, solution of silver nitrate after 
cocainization. The child should not nurse from these nipples. 



OBSTETRICS AND GYNECOLOGY. 241 

Give the varieties, pathology, symptoms and treatment 
of puerperal mastitis. 

Mastitis or inflammation of the mammary gland may be 
suppurative or non-suppurative. It is almost always due to* 
septic infection occurring through a fissured nipple. Occa- 
sionally it may result from caking of the breasts or milk- 
stasis. The pathology consists essentially in an acute inflam- 
mation of the cellular tissue of the gland. The symptoms 
are acute pain, inflammation, reddening of the surface, indu- 
ration, malaise, elevation of temperature and headache. The 
treatment consists in hot compresses of lead-water and laud- 
anum, the ice-bag, the application of a mammary binder, and 
ichthyol or belladonna locally; the child should not nurse. 
The bowels should be opened. 

Give the symptoms and treatment of mammary abscess. 

If mastitis advances to suppuration the symptoms will 
change. This is most common in the third or fourth week 
of the puerperium. The pain becomes dull and throbbing; 
rigor or chills are noted; the fever becomes hectic in type; 
the indurated portion of the breast becomes softer at a certain 
point, and fluctuation may be noted ; the surface of the gland 
becomes edematous, livid and glazed. When the abscess is 
situated deeply in the areolar tissue just above the pectoral 
muscles a postmammary or submammary abscess results. In 
this case the pus is very apt to burrow, and the gland is raised 
from the chest and becomes protuberant. The treatment of 
abscess is early incision, the line of incision radiating from 
the nipple; the wound should be bathed in mercuric chlorid 
(1:4000) and packed with sterile gauze. 

What is the treatment of galactorrhea? 

Galactorrhea is an excessive flow of milk from the engorged 
breasts. It may be corrected by feeding the infant at regular 
intervals, and between the feedings the breast-pump may be 
employed to remove the excessive flow. Ergot may be admin- 
istered in small amounts, potassium iodid given in doses of 
10 grains three times daily, and belladonna ointment applied 
16 



242 OBSTETRICS AND GYNECOLOGY. 

locally, or a 5- per cent, solution of cocain in equal parts of 
glycerin and water. 

To what dangers in pregnancy and labor does gonorrhea 
of the mother expose her and her offspring? 

During pregnancy a gonorrheal woman may develop a pus- 
tube, which may rupture or cause an abortion and expose her 
to the development of septic infection. A gonorrheal woman 
is always in imminent danger of puerperal sepsis after the 
delivery of her child. The child is exposed to the danger of 
ophthalmia neonatorum. 

Give the symptoms, treatment and prognosis of oph= 
thalmia neonatorum. State its causes and the means of 
prevention. 

Ophthalmia neonatorum is a purulent inflammation of the 
conjunctiva of the infant due to infection at birth by gonor- 
rheal virus contained in the uterine and vaginal discharges. 
It is very virulent, and frequently results in total loss of sight 
from perforation of the cornea and destruction of the super- 
ficial tissues. The symptoms are reddening and edema of the 
palpebrae, agglutination of the lids, profuse purulent dis- 
charge, a bright red appearance of the conjunctiva^ and later 
ulceration and perforation of the cornea. The prognosis is 
good unless corneal ulceration occurs. The treatment is 
mainly prophylactic and this consists in frequent vaginal 
douching during labor, and, immediately after the birth of 
the head, cleansing of the eyes with warm sterilized water, 
followed by the instillation of a few drops of a 2 per cent, 
solution of silver nitrate. After the disease has' appeared 
the cleaning must be done hourly {Crede's method) with warm 
water, followed in alternate hours by mercuric chlorid 1 to 
5000 to 8000, and a saturated solution of boric acid. Twice 
daily an application of silver nitrate 4, per cent, solution may 
be used. The well eye should be protected with, a collodion 
dressing, . ,, , . 

Give the pathology of hydrocephalus. State how hydro- 



OBSTETRICS AND GYNECOLOGY. 243 

cephalus may be recognized before delivery, and how such 
a complication should be dealt with. 

Hydrocephalus is a collection of serous fluid at some point 
within the cerebral substance {internal hydrocephalus) or 
outside the brain-substance {external hydrocephalus) , pre- 
venting closure of the fontanels and causing enlargement of 
the skull. It is probably a sequel of some obscure form of 
inflammation of the cerebral meninges. The vaginal finger 
detects bulging fontanels and widely separated sutures, both 
yielding the sensation of fluctuation. Occasionally crepita- 
tion may be noted. Abdominal palpation reveals an unusual 
size of the head. The treatment consists in aseptic puncture 
through a fontanel or suture ; if this fails craniotomy is indi- 
cated. 

How may multiple (twin) pregnancy be recognized? 
State how it may complicate labor, and show how labor 
should be managed when this condition exists. 

A twin pregnancy may be recognized by the unusual size 
of the abdomen, by the presence of two distinct fetal heart- 
beats, heard best at different points of the abdominal surface ; 
there may be two distinct placental souffles, irregularity in 
the outline of the uterus, the presence of a number of fetal 
extremities or parts, and the ability to outline two fetuses. 
The dangers are uterine inertia, abnormal presentations, im- 
perfect development of the fetuses, the formation of mon- 
strosities, and locking of the babies. The first child present- 
ing normally labor should proceed normally ; after its birth 
the second child should be made to present in a proper man- 
ner, and then 1 dram of the fluid extract of ergot should be 
administered. Not infrequently a forceps-delivery is re- 
quired. 

What complications may arise in a twin labor, and how 
may they be overcome? 

, Malp resent ation and malposition are frequent ancL must t>e 
corrected. Locking of the heads requires separation i; of. Jth,e 
chins, , the* application. .of , forceps or decapitation,. |( 



244 OBSTETRICS AND GYNECOLOGY. 

What is superfetation, and how does it take place? 

Superf etation is the supposed fertilization of an ovum when 
there is another from a previous ovulation in uterogestation. 
There is considerable doubt as to the possibility of such an 
occurrence. If it does occur it will probably take place within 
the first few days after the primary conception, i. e., before 
the formation of the decidua. The occurrence of superfeta- 
tion at a more advanced stage in the development of the pri- 
marily fertilized ovum seems, however, to have been proved 
by remarkable cases reported by eminent men. 

What is meant by prolapse of the funis? When does it 
occur? What are its dangers? How would you manage 
such a case? 

Prolapse of the cord consists in the descent of a loop of the 
umbilical cord in advance of the presenting fetal portion. 
It occurs in certain malpositions and malpresentations of the 
fetus, in multiple pregnancy, in hydramnios with sudden 
escape of the liquor amnii, and in contracted pelvis when the 
fetal head does not properly fit into the superior strait. The 
danger is fetal death from asphyxiation due to pressure on 
the cord. The treatment consists in replacement of the cord, 
the woman resting in the knee-chest or Trendelenburg post- 
ure. This may be accomplished by gravity, aided by the hand 
or by a repositor. If this fails podalic version may be per- 
formed or the child hastily delivered by forceps. 

What is premature respiration? 

The establishment of the function of respiration before 
delivery of the child has been accomplished. This is due to 
the entrance of air into the birth-canal, and occurs in cases 
of dystocia or during the performance of version. The dan- 
ger is insufflation of liquor amnii or clots, with the develop- 
ment of fetal pneumonia. 

How does constitutional syphilis in the parents affect 
the infant, and how can y«ta dstsct its presence in the 
infant? 

The offspring of syphilitic parents is generally infected by 



OBSTETRICS AND GYNECOLOGY. 245 

the disease. Congenital syphilis will be shown by the follow- 
ing symptoms: Undersize of the fetus, delivery at term of a 
still-born baby, syphilitic pemphigus on the palms and soles, 
enlargement of the liver and glands of the body, catarrhal or 
white pneumonia, and a line of fatty tissue between the epi- 
physis and diaphysis of the long bones. If the child be 
born alive and apparently healthy it will develop a coryza or 
"snuffles" at the expiration of four or five weeks, followed 
by the appearance of eruptions over the body and the devel- 
opment of marasmus. 

Give the causes and treatment of umbilical hemorrhage 
of the new=born child. 

Primary omphalorrhagia results from loose ligature or 
laceration of the cord, and occurs immediately after birth. 
Secondary hemorrhage occurs at the time of separation of the 
cord, and is due to a dislodgement of the clots or to the hem- 
orrhagic diathesis. The treatment consists in religation of 
the cord, the application of a firm compress with an astringent 
solution, the application of a firm plaster of Paris dressing, 
or of a figure-of-eight ligature applied over hare-lip pins. 

How would you decide whether a dead infant had been 
born alive? 

By the presence of air in the lungs (hypostatic test). 

What are the causes of still=birth, and how should a 
stillborn child be treated? 

The causes of still-birth are various intrauterine diseases, 
asphyxia from pressure on the cord or interference with the 
fetoplacental circulation, as in eclampsia or premature sepa- 
ration of the placenta, and traumatism during some obstetric 
operation. Should a child should be handled tenderly and 
be given a decent burial. The term "still-birth" should not 
be confounded with asphyxia neonatorum. 

Give the etymology and uses of the forceps, and name 
the conditions for their application, together with the 
rules therefor and precautions to be observed in the same. 

The obstetric forceps (a Latin word) is an instrument with 



246 OBSTETRICS AND GYNECOLOGY. 

two blades and handles for pulling, grasping or compressing 
the fetus. Its use is indicated by the presence of uterine 
inertia, minor degrees of pelvic contraction, threatened fetal 
or maternal life, and to correct malpositions of the fetal head. 
In order that the instrument may be applied the os must be 
dilated, the membranes ruptured, there must not be too great 
disproportion between the head and the birth -canal, the part 
should be engaged, and the' labor must be possible. The left 
blade is always introduced first, and must be grasped in the 
left hand and carried to the left side of the patient. It must 
not be forcibly thrust in, but must be slightly rotated in order 
to accommodate it to the pelvic and fetal curves. The blade 
that corresponds in name to the pelvic diameter in which the 
fetal presentation is lying must be pried forward in order to 
grasp the fetal head on the sides. , 

Describe the common varieties of obstetric forceps. 

A short forceps is one in which the blades are attached 
directly to the handles without the intervention of a shank; 
it has the cephalic curve only, and is used only when the head 
is on the pelvic floor {low forceps operation). The long for- 
ceps is one in which a shank is placed between the handles 
and the blades ; it has a pelvic curve, as well as the cephalic. 
It may be used at the superior strait, but usually is applied 
to the head- in the pelvic cavity (median forceps operation). 
The axis-traction forceps is a long forceps, in which, by an 
appliance or supplementary handle attached to the under 
surface of the blades, the traction force is constantly exerted 
in the line of the axis of the parturient canal. It is used at 
the superior strait (high forceps operation). 

Describe the position of patient and physician for the 
readiest means of applying the forceps. 

The patient in this country lies upon her back in the litho- 
tomy positon, with the limbs flexed and the buttocks over the 
side of the bed. The physician sits on a chair between the 
thf ghs, which are separated and held by assistants. 



OBSTETRICS AND GYNECOLOGY. 247 

In what direction should traction be made when the 
fetal head is in the cavity of the pelvis? 

At first downward and outward, then upward and backward. 

What powers may be exerted by the forceps? 

The forceps are generally used as tractors. They may be 
employed as levers, rotators and compressors. 

What are the dangers in the use of forceps, and how are 
such dangers to be avoided? 

The dangers are slipping of the instrument, septic infec- 
tion, laceration of the cervix and soft tissues, and fatal com- 
pression of the fetal head. If applied gently, without force, 
and in the proper (less) diameters of the fetal skull, and if 
thorough asepsis be employed, these dangers may be obviated. 

Describe the technic of the high forceps operation. 

The instrument (axis-traction forceps) must be introduced 
through the cervix, and applied to the head in the best diam- 
eter possible. The grip is a vicious one, because a large diam- 
eter must be seized and there is danger of slipping. Traction 
is made well down at first, and as the head descends and the 
upper handles of the instrument rise the extra handles must 
be raised in order to keep the two handles together. When 
the head is low enough the instrument should be withdrawn 
and reapplied in a better position, or a simple instrument 
used. 

Describe the occasion for the application of the forceps 
in the inferior strait. 

This is a low operation. The blades are introduced in the 
manner already described, and traction made outward and 
downward until the floor is reached. The head is then pulled 
upward and outward and then upward and backward until 
it emerges through the vulvar orifice. The instrument in the 
last stage of delivery is grasped in the right hand only, as a 
dagger would be held, and the left hand spans the perineum 
in order to regulate the degree of distension. 



248 OBSTETRICS AND GYNECOLOGY. 

Describe the use of the forceps in the occipito=posterior 
position. 

This is a double forceps-operation. The occiput generally 
lies in the right oblique diameter (B. 0. P.)- After applying 
the forceps in the manner already described traction is made 
downward and outward until the head impinges upon the 
pelvic floor. In the intervals of relaxation a certain amount 
of anterior rotation will take place. This will carry the occi- 
put through the transverse and into the left oblique diameter. 
The forceps must then be removed and reapplied in the new 
diameter to prevent inversion of the instrument. The final 
traction and delivery are as in the ordinary anterior forceps- 
delivery. 

What indications would lead you to insert a hand into 
the uterus, and what precautions should you observe? 

Failure of the placenta to descend, active post-partum 
hemorrhage, and the necessity for the performance of version 
are the indications for the introduction of the hand into the 
uterus. Thorough asepsis and antisepsis must be observed, 
and the hand must be annointed with an antiseptic ointment. 

Define version. Give the varieties, indications and 
dangers of version, together with the preliminaries and 
the method of operating. 

Version or turning is an obstetric operation whereby by 
manual efforts the position of the fetus in utero is altered so 
that one extremity of the fetal ellipse is made to take the place 
occupied by the other extremity or by some portion of the 
trunk. The varieties of version are: 1. Cephalic, in which 
the head is made to present ; 2. Pelvic, in which the breech is 
caused to present at the superior strait; and 3. Podalic, in 
which one or both feet are grasped and drawn down into the 
parturient canal. The indications for version are malposi- 
tion of the head and malpresentations, minor degrees of pelvic 
contraction, placenta prgevia, anything indicating speedy 
delivery of the child, as threatened fetal or maternal life, and 
sudden death of the mother. The dangers of the operation 



OBSTETRICS AND GYNECOLOGY. 249 

are the introduction of septic matter or of air, with the pro- 
duction of air-embolism, rupture of the uterus, laceration of 
the cervix, and serious fetal injury. The patient should be 
anesthetized, and every antiseptic precaution observed. The 
membranes should not be ruptured until the hand is ready to 
be introduced. One foot should be grasped with the heel in 
the palmar surface and the child gently turned to avoid undue 
distension of the lower uterine segment. After the body is 
turned the case is treated as a breech presentation. 

Compare version with the employment of forceps, and 
state when each is preferable. 

Version is a shorter operation, and one that is to be pre- 
ferred when haste is required. The dangers of sepsis are 
greater than in the use of forceps, and also the danger of 
uterine rupture. Version should be used w r hen the forceps 
fail to engage the head in minor degrees of pelvic contraction. 
Version cannot be employed when engagement has occurred 
or when there is a high position of Bandl's ring. 

Describe symphyseotomy, and give the indications for 
its performance. 

Symphyseotomy or division of the pubic symphysis is an 
extremely limited operation. It should be done, if done at 
all, only in those cases of pelvic contraction in which the con- 
jugate diameter of the superior strait measures from 7 to 8 
cm. The operation of choice is the indirect method, in which 
an incision V/ 2 to 2 inches long is made above the symphysis 
in the median line, and after separation of the muscles the 
Galbiati knife is passed down beneath the symphysis and the 
bone divided from below upward and from within outward. 
As the symphysis separates gauze is packed in to arrest hem- 
orrhage. The forceps is then applied and the child extracted. 
After delivery the wound is closed and the bones held in appo- 
sition by means of a firm pelvic binder. 

Define embryotomy and craniotomy, and give the indi- 
cations for and method of operating in each. 

Embryotomy is any mutilating operation upon the fetus. 



250 OBSTETRICS AND GYNECOLOGY. 

It includes decapitation or beheading of the fetus, amputa- 
tions of the fetal extremites, evisceration, or removal of the 
.viscera piecemeal, and craniotomy, or opening of the fetal 
skull, with evacuation of the brain. The technic of crani- 
otomy is as follows : Vaginal asepsis, fixation of the head and 
scalp with volsella-forceps, perforation through a suture or 
fontanel, enlargement of the perforation, disorganization of 
the brain-mass, decerebration by intracranial injections of 
warm carbolized water, crushing of the skull, and extraction 
of the head by the craniotractor. 

Give the various steps in embryotomy in the transverse 
presentation. 

If the fetus presents by the back, the operation of spon- 
dylotomy or division of the vertebrae is indicated, followed by 
evisceration or by delivery of the fetal body doubled upon 
itself. Spondylotomy or rachiotomy is performed by means 
of scissors, as is also evisceration. Occasionally in impacted 
shoulder presentations the operation of decapitation will be 
indicated. This can be accomplished by means of the blunt 
or the sharp hook or by scissors. The body is .readily re- 
moved, and the head must then be grasped by forceps, 
crushed and extracted. 

Give the condition requiring Cesarean section or hys- 
terectomy, and describe a modified form of the operation. 

Cesarean section or delivery of the child through an abdom- 
inal and uterine incision is indicated in grave degrees of pel- 
vic contraction, in labor obstructed by tumors of the uterus 
and pelvis, in irreducible vaginal tumors, in rupture of the 
uterus, and in sudden maternal death. The original Cesa- 
rean section, in which an incision was made into the uterine 
wall and the child extracted, has been modified by Sanger as 
follows : The abdomen is opened in the median line, the uterus 
delivered and towels packed around it. Then while the uter- 
ine arteries are controlled by an assistant an incision is made- 
into the uterus and the child and placenta extracted. The 
uterine cavity is cleaned out and sutures introduced to close 



OBSTETRICS AND GYNECOLOGY. 251 

the uterine incision, after which the abdominal wound is 
closed. 

Define Porro's operation, state when it is applicable, 
and describe the method of its performance. 

The Porro operation or celiohyst erect omy consists in the 
extirpation of the uterus and its appendages after the extrac- 
tion of the fetus, as in the simple Cesarean section. The indi- 
cations for this operation are extreme degrees of pelvic con- 
traction, marked atresia of the cervix, vagina or vulva, the 
presence of large bony growths in the pelvic canal, large 
fibrous or myomatous tumors of the uterus, extensive rupture 
of the uterus, with involvement of adjacent structures, a 
relaxed and flabby condition of the uterus after the section, 
and a septic condition of the uterus, with threatened general 
septic infection. The operation is the same up to extraction 
of the child. The ovarian and uterine arteries are then 
ligated and the uterus amputated at the cervical junction. 
The case is then treated as an ordinary abdominal section. 

What complications in labor justify abdominal section? 
Give the technic of the operation. 

The conditions that indicate Cesarean section, rupture of 
the uterus, retrodisplacement of the uterus with incarceration, 
extrauterine pregnancy, labor complicated with tumors, grave 
septic infection of the uterus, appendages or broad ligament, 
all indicate abdominal section. The technic is that of Cesa- 
rean section with or without the removal of the uterus. 

Describe the malformations of the uterus. 

Owing to failure of development of the ducts of Miiller we 
have varying degrees of double uterus. The slightest degrees 
are known as uterus incudiformis and uterus cordiformis. 
From these minor degrees the uterine deformity may advance 
through the stages of uterus septus, subseptus, partitus, bi- 
partitus, ~bilocularis and semipartitus. In the uterus bicornis 
the two tubes unite below, but are separated above. The 
uterus unicornis results from a lack of development of one of 
the Miillerian ducts, its fellow undergoing the normal process 
of evolution. 



252 OBSTETRICS AND GYNECOLOGY. 

Describe and differentiate anteversion, retroversion and 
prolapsus of the uterus. State the obstetric significance 
of each. 

Anteversion of the uterus is a bending of that organ for- 
ward; retroversion is a bending backward; prolapsus is a 
falling down or descent of the organ. Anteversion may 
prevent a rising of the uterus if the organ be fixed, and so 
interfere with pregnancy. Retroversion of a pregnant womb 
may result in incarceration with serious results. Prolapse 
does not as a rule interfere with gestation ; the uterus returns 
to its normal position as gestation advances. 

Mention the symptoms and give the management of 
long=retained excretions due to imperforate hymen. 

In addition to menstrual suppression there will be noted 
cramp-like pains and a steadily growing cystic tumor in the 
median line of the abdomen. Palpation will elicit pain. Va- 
ginal examination will show the imperforate condition of the 
hymen. The treatment consists of thorough asepsis, followed 
by cervical incision into the hymen. As the tarry fluid es- 
capes a two-way catheter should be introduced and an anti- 
septic solution allowed to flow into the uterus in order to 
prevent shock from sudden evacuation and to prevent septic 
infection. 

What is vaginismus? How may it be recognized and 
treated? t 

Vaginismus is painful spasm of the vagina and vulva. It 
results from rigid hymen, fissure and other local conditions, 
and appears at the time of coitus or digital exploration. It 
is best treated by dilatation under anesthesia. 

What methods should be employed to dilate the non- 
pregnant uterus, and under what circumstances is the 
operation justifiable? 

The best method of dilating the uterus is the use of the 
dilator of Goodell or Wathens, the glove-stretching apparatus. 
This is required whenever there is stenosis of the cervical 
canal, or as a preliminary step to the operation of curettage. 



OBSTETRICS AND GYNECOLOGY. 253 

Is ventrofixation of the uterus justifiable? If so, state 
under what circumstances, and describe the operation. 

. It is a safe and proper operation for the correction of 
retrodisplacement of the uterus in women past the child- 
bearing period. An abdominal opening is made, the uterus 
is brought forward, and a stitch is passed through the peri- 
toneal and subperitoneal tissues on one side of the incision, 
then through the fundus of the uterus on a line with the 
Fallopian tubes and through the corresponding tissues on the 
other side. A second suture must be passed a little back of 
this and firmly secured. The abdominal Avound is then closed. 
Under what conditions may shortening of the round 
ligament become justifiable, and how should the operation 
be performed? 

Shortening of the round ligament may be performed when 
there is a retrodisplacement of the uterus. It is best per- 
formed by Wylie 's method or some other of the intraperitoneal 
methods, the ligaments being folded upon themselves or im- 
planted further back upon the uterus. Alexander's opera- 
tion is shortening of these ligaments in the inguinal canals. 

Define salpingitis, state its causes and pathology, and 
give its management. 

Salpingitis is inflammation of the Fallopian tubes. It may 
be septic, gonorrheal or tuberculous in origin, or merely a 
catarrhal condition. The mucosa swells, secretes a fluid, and 
if the edges of the fimbriae adhere a retention-cyst is formed. 
The treatment may be derivative, and consist in purgation, 
with local applications to the cervix and vaginal vault, or 
abdominal section may be performed and the appendages 
removed. 

Give the pathology of (a) hydrosalpinx, (b) hematosaN 
pinx. Give the diagnosis and treatment of each. 

Hydrosalpinx, or a watery collection in the tube, results 
from an old pyosalpinx or purulent collection. The pyogenic 
membrane has become destroyed, and the fluid slowly assumes 
the watery nature. Hematosalpinx, or blood in the tube, 



254 OBSTETRICS AND GYNECOLOGY. 

results almost invariably from an extrauterine pregnancy. 
The treatment of each is excision. The diagnosis is made by 
the presence of a sensitive tumor in the situation of the tube, 
with pain on the affected side. , 

Define endometritis, and give its causes, varieties and 
treatment. 

Endometritis, or inflammation of the lining membrane of 
the uterus, may be septic, gonorrheal, traumatic, catarrhal 
or tuberculous in origin, and occur as a glandular or as an 
interstitial affection, or as both combined. It may be treated 
by local applications, depletion, curettement, intrauterine 
applications, or by excision of the uterus. 

Give the causes of pelvic inflammation, and state its 
relation to involvement of the ovary. 

Pelvic inflammation is generally septic or gonorrheal in 
origin. It may result from exposure to cold or wet or from 
abrupt stopping of the menstrual discharge. If active and 
virulent or long continued there follows a thickening and 
chronic inflammation of the ovarian capsule, which will result 
in follicular cysts forming in the ovarian stroma from in- 
ability of the Graafian follicles to rupture. . 

■\ Give a differential diagnosis between ovaritis and 
pvaralgia. 

Ovaritis, or inflammation of the ovary, is associated with 
all the symptoms of pelvic inflammation, including pain, leu- 
korrhea, hemorrhage, menstrual disturbance and swelling of 
the ovary or tumor-formation. There will also be general 
symptoms, as fever and prostration. Ovaralgia is neuralgia 
of the ovary, and may exist independently of any appreciable 
local Lesion. It is -more apt: to, occur at or .near the -menstrual 
period. - .- ■ . 

r Give the pathology and treatment of an ovarian cy^t. 

- An ovarian cyst may be follicular, as already described. 
It may be a multilobular cyst arising from rudimentary Gra- 
afian follicles, and consisting of » two or more i loeuli or com- 



OBSTETRICS AND GYNECOLOGY. 255 

partments ; it may be a unilocular cyst springing from the 
parovarium, or it may be a papillary growth arising in the 
vertical tubules of the paroophoron. Whatever its origin 
and pathology, it should be removed by abdominal section. 

Give a description of cystocele and rectocele. State 
how each may complicate labor, and what should be done 
in the arising contingency. 

Cystocele is a prolapse of the anterior vaginal wall and 
posterior bladder wall ; rectocele is a prolapse of the posterior 
vaginal wall and anterior rectal wall. Both cystocele and 
rectocele encroach upon the calibre of the vagina, and may be 
caught by the advancing fetal head either arresting its pro- 
gress or being pushed before the head; in the latter case the 
submucous tissue is torn and the vaginal prolapse made worse. 
The treatment consists in applying forceps to the head and 
drawing it over the relaxed vaginal walls. 

How would you diagnose cystic degeneration of the 
ovaries from other forms of disease which simulate it? 

From ascites ovarian cyst may be distinguished by the cen- 
trally situated tumor, the area of central dulness with corona] 
resonance, the immovability of the tumor, and the protuberant 
abdomen when the woman assumes the dorsal position. In 
ascites the abdomen flattens and the flanks bulge when the 
woman lies upon her back; a change of position causes a cor- 
responding change in the area of dulness; fluctuation is 
marked; there is an area of central resonance with coronal 
dulness, and an associated grave organic disease may be de- 
tected. In phantom tumor the percussion-note is hyper- 
resonant, and examination under an anesthetic reveals the 
true condition. 

Give the early diagnosis and the treatment of cancer of 
the uterus. 

"\ A recurrence of bleeding after the menopause; an angry 
appearance of the cervix, which bleeds on the slightest touch; 
a peculiar hardness of the mucous membrane due to cellular 



256 OBSTETRICS AND GYNECOLOGY. 

infiltration; an acid and irritating discharge, which may or 
may not be fetid, and dull sacral pains would lead to the sus- 
picion of cancer. A microscopic examination would then 
complete the diagnosis. The only treatment consists in total 
extirpation of the uterus. 

Give the diagnosis and treatment of anemia and chlo- 
rosis. 

Chlorosis is the "green sickness" of young girls. These 
girls are generally stout and well nourished, but present a 
peculiar green color; they suffer from nosebleed not infre- 
quently and attacks of vertigo and syncope. In true anemia 
there is an extreme pallor, with marked diminution in the red 
blood-corpuscles and hemoglobin and more or less wasting. 
Anemia is generally associated with some grave organic dis- 
ease. The treatment of both conditions consists in good food, 
change of scene, rest and tonics, including iron, strychnin 
and arsenic. 

What are the symptoms and treatment of amenorrhea? 

Amenorrhea is a total suppression of the menstrual flow. 
It is generally associated with anemic conditions, and may be 
accompanied by leukorrhea and vague pelvic pains. The 
treatment consists in tonics, good food, and the use of iron, 
oxalic acid, potassium permanganate, manganese and the 
other so-called emmenagogues. 

What is the menopause, and in what manner would you 
explain the theory that it is a critical period in a woman's 
life? 

The menopause is the cessation of the phenomenon of men- 
struation, occurring usually at the age of 43 to 45. At this 
time the ovarian influence ceases, and because of the tendency 
to the development of obesity and of uterine cancer at or 
after this period it has long been regarded as a critical period 
in the life of the woman. Various forms of insanity may 
also develop at this time. The post-climacteric diseases may 
assume a very serious aspect. 



SURGERY. 



Describe a cartilaginous tumor. Where are such 
growths most commonly found? 

A cartilaginous tumor (chondroma) is a tumor composed 
of hyaline cartilage. They are most commonly found in con- 
nection with some of the long bones, particularly the meta- 
carpal bones and phalanges of the hand, the humerus, the 
tibia, the femur, and rarely the ribs. They may also occur 
in the parotid gland, testicles, breast, or thyroid gland, but 
in these situations they are usually associated with some other 
variety of tumor. 

Mention the inflammatory diseases of bone. 

Periostitis, ostitis, and osteomyelitis. 

What is inflammation? How does inflammation extend 
and how may it terminate? 

''Inflammation is the succession of changes which occur in 
a living tissue when it is injured, provided that the injury is 
not of such a degree as to at once destroy its structure and 
vitality." (Burdon Sanderson.) 

Inflammation may extend by continuity, by contiguity, 
through the blood vessels, and through the lymphatics. 

Inflammation may terminate by resolution, retrogression, 
suppuration, ulceration, or gangrene. 

State the distinction between the antiseptic and aseptic 
wound treatment. 

In antiseptic wound treatment an effort is made to destroy 
the germs in a wound, as well as to prevent the entrance of 

( 257 ) 
17 



258 SURGERY. 

more bacteria. The greatest reliance is placed upon chemical 
agents. 

In aseptic wound treatment an effort is made to prevent the 
entrance of germs into a wound. The greatest reliance is 
placed upon mechanical purification and upon sterilization 
by heat. 

Mention the general characteristics of a benign tumor 
as distinguished from a malignant tumor. 

Benign tumors, in contradistinction to malignant tumors, 
are usually encapsulated, grow slowly, do not infiltrate, are 
not painful (except by pressure), do not give metastasis, do 
not recur upon removal, produce no cachexia, and do not cause 
death (except by location). 

What are the indications for ligature of the lingual 
artery? Give the steps of the operation, omitting aseptic 
details. 

The lingual artery is most frequently tied as a preliminary 
procedure to removal of the tongue. Other indications for 
its ligation are to control hemorrhage from the artery or its 
branches, to check the growth of advanced carcinoma of the 
tongue, and certain cases of macroglossia. 

The patient should be on his back, his shoulders raised, and 
his head extended and turned to the opposite side. Starting 
just below the symphysis of the chin, an incision is made 
which passes downward and outward to the greater cOrnu of 
the hyoid bone, and then upward to the angle of the jaw, 
ending at about the level of commencement of the incision, 
but not endangering the facial artery. This incision divides 
the integument, both layers of the superficial fascia with the 
enclosed platysma, and exposes a portion of the submaxillary 
gland. The deep fascia covering the submaxillary gland is 
now incised and the gland loosened and held up by a retractor. 
We have now exposed Lesser 's triangle, formed by the hypo- 
glossal nerve above and the two bellies of the digastric muscle 
below. The floor of this triangle is formed by the hyoglossus 
muscle. The stylo-hyoid and the tendon of the digastric are 



SURGERY. 259 

now drawn downward, the lingual vein and the hypoglossal 
nerve are drawn upward, and an incision is carefully made 
through the hyoglossus muscle just above the hyoid bone. In 
making this last incision, which exposes the artery, care must 
be taken to avoid wounding the middle constrictor and con- 
sequently opening the pharynx. The submaxillary gland 
and its duct must also be protected from injury lest a salivary 
fistula result. The aneurism needle is now passed about the 
artery, the ligature tied, the external wound sutured, and an 
aseptic dressing applied. The artery may also be secured 
before it passes beneath the hyoglossus, and the danger of 
opening the pharynx is thus greatly lessened. 

Name the different varieties of malignant tumors. 

Sarcoma (round, spindle, and giant-cell, melanotic, alve- 
olar, lympho-sarcoma, and endothelioma) and carcinoma 
(epithelioma, scirrhus, encephaloid, melanotic, and colloid). 

What are the chief affections of the scrotum? 

Intertrigo, eczema, erysipelas, ecchymosis, edema, chancre, 
chancroid, syphilitic eruptions, tubercular ulceration, ele- 
phantiasis (lymph-scrotum), urinary fistula, tubercular sin- 
uses, gangrene, lipoma, sebaceous cyst, and epithelioma, 

What other methods beside the use of the knife are 
employed to remove a carcinoma from superficial surfaces? 

Caustics and the X-rays. 

Name the principal operations for stone in the bladder. 

Perineal lithotomy, supra-pubic lithotomy, and litholapaxy. 

Name the different varieties of benign tumors. 

Lipoma, fibroma, chondroma, osteoma, glioma, myxoma, 
angioma, lymphangioma, myoma, neuroma, adenoma, and 
papilloma. 

Relate the causes of intestinal obstruction. 

Acute obstruction : 1. Strangulation by bands, adhesions 
or apertures; 2. Volvulus; 3. Impaction of foreign bodies; 



260 SURGERY. 

4. Kinking of the gut (rare) ; 5. Acute intussusception; 6. 
The termination of a chronic obstruction. 

Chronic obstruction : 1. Impaction of feces, gall-stones, for- 
eign bodies ; 2. Intestinal affections, such as stricture, tumors, 
angulation of the gut from contraction of adhesions, matting 
together of intestinal coils; 3. Compression of the intestine 
by tumors or exudates outside of the bowel. 

Describe the ligation of the femoral artery at any 
selected point. 

Ligation at the apex of Scarpa's triangle. The line of the 
artery is from a point midway between the anterior superior 
spine of the ilium and the symphysis pubis to the adductor 
tubercle on the inner condyle of the femur. The patient 
should be on his back, with the thigh abducted, rotated out- 
ward, and slightly flexed. After all aseptic details have been 
carried out, an incison is commenced three inches below Pou- 
part's ligament and carried downward for about three inches 
in the line of the artery, dividing the skin, superficial fascia, 
and fascia lata. If the lymphatic glands are exposed they 
may be held to one side or removed. In making the incision 
the internal saphenous vein should not be wounded. The 
sartorius muscle should now be located, and beneath this mus- 
cle the artery will be found. Remember that the fibers of the 
sartorius run downward and inivard, while those of the 
adductor longus run downward and outward. The sheath 
should be opened upon the outer side and the crural branch 
of the genito-crural nerve and the long saphenous nerve 
avoided. The aneurysm needle is to be passed from within 
outward. The cutaneous wound is then sutured and asep- 
tic dressing applied. 

What are the chief surgical diseases of the groin? 

Inguinal hernia, femoral hernia, lymphadenitis, and en- 
cysted hydrocele of the cord. Psoas abscess, hip disease, and 
pelvic abscess may give rise to swellings, which are first 
observed in the groin. 



SURGERY. 261 

How are wounds classified? 

Incised, lacerated, contused, punctured, poisoned, and gun- 
shot. They may also be divided into septic and aseptic. 
Wounds in the vicinity of great serous cavities are divided 
into penetrating and non-penetrating. Wounds are also 
spoken of as being either subcutaneous or open. 

Describe the anastomosis which takes place after liga= 
tion of the femoral artery at its middle third. 

The profunda femoris anastomoses with the articular 
branches of the popliteal and with the tibial recurrent; the 
comes nervi ischiadici anastomoses with the perforating 
branches of the profunda femoris and with the articular 
branches of the popliteal and tibial recurrent. 

Where should the opening be made in order to reach the 
antrum in a case of abscess of the middle ear? 

In the posterior superior angle of the suprameatal triangle 
of Macewen, which is bounded above by the posterior root of 
the zygoma, in front by the upper and posterior segment of 
the osseous external meatus, and behind by a line drawn tan- 
gent to the bony meatus and almost at right angles to the 
posterior root of the zygoma. The chisel is to be directed 
slightly forward to avoid wounding the sigmoid sinus, and 
care should be taken to avoid injury to the facial nerve. 

What agents are employed for the production of local 
anesthesia? 

Ice and salt, carbolic acid, ethyl chloride, cocaine (intra- 
dermic, infiltration, perineural and paraneural methods), 
eucaine, and nirvanin. 

What are the causes of secondary hemorrhage? 

Chief cause: Septic arteritis. 

Contributory causes: 1. Early absorption of ligature; 2. 
Faulty application of ligature; 3. Ligature too near a col- 
lateral branch; 4. A diseased condition of the arterial wall; 
5. A state of the blood unfavorable to wound repair (albu- 
minuria or diabetes) ; 6. Increased blood pressure (plethora, 



262 SURGERY. 

Bright 's disease, fever, excitement, injudicious administra- 
tion of stimulants). 

What are the causes of esophageal stricture? 

Congenital narrowing, the cicatricial contraction of healed 
ulcers (due to the ingestion of corrosive liquids or to syphilis), 
carcinoma, polypoid tumors projecting from the mucosa, and 
external pressure (aneurism, goitre, sarcoma of glands or of 
vertebras, pericardial effusion). Strictures near the cardiac 
orifice may arise from the healing and contraction of a gastric 
ulcer. 

At what point is paracentesis thoracis preferably per= 
formed? 

At the most dependent point of the effusion. The site 
usually selected is in the seventh or eighth interspace just 
below the angle of the scapula or in the posterior axillary line. 

What are the predisposing and what are the exciting 
causes of abdominal hernia? 

Predisposing causes : Early life, male sex, occupations de- 
manding great muscular exertion, structural defects (elonga- 
tion of the mesentery, a patent funicular process), heredity, 
relaxation of the abdominal wall from disease, weakening of 
certain portions of the abdominal wall by injury or operation, 
phimosis, pertussis, bronchitis, urethral stricture and consti- 
pation. 

Exciting cause: Any increase of the intra-abdominal pres- 
sure. 

What are angiomata? 

Angiomata are tumors composed of blood vessels, some of 
which are of new formation. 

Define volvulus and give its treatment. 

By volvulus is meant a twisting of the gut in such a manner 
that the intestinal lumen is occluded and the circulation of 
the bowel affected. Treatment : Celiotomy. An attempt may 
be made to untwist the intestine, but this is usually impos- 



SURGERY. 263 

sible. If the attempt succeeds a recurrence of the condition 
should be guarded against by shortening the mesentery. If 
the attempt fails one of three courses may be pursued : 

1. An anastomosis may be performed between the bowel 
above and that below the volvulus. 

2. Resection of the portion of intestine involved, followed 
by circular enterorrhaphy. 

3. The making of an artificial anus. If the large intestine 
is involved, as is usually the case, the latter course is prob- 
ably the best one. 

What is an abscess? 

An abscess is a circumscribed collection of pus in a cavity 
of abnormal formation. 

How does a carbuncle differ from a furuncle? 

A carbuncle is a gangrenous inflammation commencing in 
the subcutaneous tissues and extending to the skin. Car- 
buncles, are usually single, occur most commonly after middle 
life, show a predilection for the back of the neck or inter- 
scapular region, and discharge through more than one open- 
ing. They are larger, natter, and accompanied by greater 
constitutional disturbances than are furuncles. 

A furuncle is a gangrenous inflammation commencing in 
the skin and extending to the subcutaneous tissues. Fur- 
uncles are usually multiple, occur most commonly during 
adolescence and early adult life, show no predilection for any 
portion of the body, and discharge through a single central 
opening. They are smaller, more conical, and accompanied 
by less constitutional disturbance than are carbuncles. 

What anesthetic would you select for an operation about 
the mouth? 

Chloroform, unless contra-indicated. 
What is an adenoma? 

An adenoma is a tumor, the minute structure of which re- 
sembles that of a gland. Unlike normal glands, these tumors 
have no secretory ducts and no physiologic function. 



264 SURGERY. 

Through what channels is carcinoma disseminated? 

Through the lymphatic channels. 

What agents are employed for the production of general 
anesthesia? 

Nitrous oxide, ether, chloroform, and bromide of ethyl. 
Describe a dissecting aneurysm. 

A dissecting aneurysm is one in which the blood breaks 
through an atheromatous ulcer in the intima and burrows its 
way through the substance of the media ; the sac of the aneu- 
rism is formed within the wall of the vessel. 

What are the varieties of hydrocele? 

Hydroceles of the cord: 1. Diffuse; 2. Encysted. 

Hydroceles of the testicle: 1. Vaginal; 2. Congenital; 3. 
Infantile; 4. Hydrocele of the funicular process (lower por- 
tion) ; 5. Encysted; 6. Hydrocele of a hernial sac. 

Enumerate the diagnostic points in intussusception. 

Colicky abdominal pain, vomiting, tenesmus, the passage 
of blood-stained mucus or pure blood, and the presence of a 
sausage-shaped tumor, which usually is situated in the line 
of the colon, an absence of resistance being observed in the 
iliac fossa. In advanced cases rectal examination may reveal 
the presence of the intussusceptum. Acute intussusception 
is more common in early childhood; chronic intussusception 
is more frequently observed in adults. 

What structures are divided in the operation for stran= 
gulated femoral hernia? 

Skin, superficial layer of superficial fascia, cribriform fas- 
cia, femoral sheath, septum crurale, subserous areolar tissue, 
parietal peritoneum, and the seat of constriction, which is 
practically always the lunated edge of Gimbernat's ligament. 
The superficial external pudic artery is always cut and the 
superficial epigastric is usually divided. 

With what conditions may aneurysm be confounded? 

Abscesses, tumors and cysts which are situated near a blood- 
vessel, and pulsating tumors of bone. 



SURGERY. 265 

Where is the swelling and fluctuation most prominent 
in synovitis of the ankle joint? 

At both sides of the tendo Achillis and in front of both 
malleoli (between the external malleolus and the extensor 
communis digitorum tendons and between the internal mal- 
leolus and the tibialis anticus tendon). 

Give a classification, either original or from competent 
authority, of burns. 

Dupuytren 's classification is the best. He divided all burns 
into six classes or degrees : 1. Superficial burns followed by 
redness and desquamation of the epidermis; 2. Burns fol- 
lowed by the formation of vesicles or bullae; 3. Burns de- 
stroying the cuticle and a portion of the true skin; 4. Burns 
extending into the subcutaneous areolar tissue; 5. Burns 
involving deeper structures, such as muscles and tendons; 6. 
Burns involving all of the constituents of the part. 

Define an acute and a chronic abscess. 

An acute abscess is one which develops with all the signs 
and symptoms of inflammation. It contains pus. 

A chronic abscess is one which is formed without the signs 
and symptoms of inflammation. As a rule they are tuber- 
cular, and do not contain true pus unless a mixed infection 
has occurred. 

Mention the causes of dislocation. Give the cardinal 
symptoms of dislocation. 

Predisposing causes : 1. The anatomic peculiarities of the 
joint; 2. "The situation of the joint; 3. Active adult life; 4. 
The male sex. 

Exciting causes: 1. External violence (direct or indirect) ; 
2. Muscular action. ,, 

Symptoms: 1. An alteration in the shape of the joint, the 
displaced articular extremity being frequently felt in an 
abnormal position; 2. An alteration in the length of the 
affected member (shortening or elongation) ; 3. More or less 
immobility of the affected joint ; 4. An alteration in the direc- 
tion of the axis of the extremity. 



266 SURGERY. 

Dislocations, like fractures, are usually accompanied by 
pain, swelling and ecchymosis. 

How are amputations classified in regard to time of 
operating? What period is most favorable for operation? 

Primary; the amputation is performed before the develop- 
ment of inflammation. 

Intermediate; the amputation is performed during the ex- 
istence of active inflammation. 

Secondary; the amputation is performed after the subsi- 
dence of the inflammatory phenomena. 

The primary period is the one most favorable for operation. 

Under what circumstances should an artery be ligated 
in its continuity? What instruments are required for the 
operation? 

An artery should be ligated in its continuity to check 
hemorrhage, to promote the cure of an aneurysm, to diminish 
the rate of growth of a tumor, to reduce the blood supply of 
an organ, and as a preliminary step to the removal of some 
vascular structure (such as the tongue). The instruments 
required are a scalpel, dissecting forceps, retractors, a grooved 
director, several hemostats, an aneurism needle, ligatures, nee- 
dles, and sutures. 

What are the causes of stricture of the rectum? 

Congenital malformation, syphilis, carcinoma, dysentery, 
tuberculosis, gonorrhea, traumatism or operations involving 
the greater portion of the circumference of the bowel, repeated 
attacks of inflamed hemorrhoids, chronic proctitis, inflam- 
matory thickening outside of the gut, as in cases of pelvic 
cellulitis after labor, and tumors pressing upon the rectum 
and narrowing its lumen. 

Define nephrorrhaphy, nephrotomy, nephrectomy. Give 
an indication for the performance of each. 

By nephrorrhaphy is meant the stitching of a kidney to the- 
posterior wall of the abdomen. Indication, floating kidney. 



SURGERY. 267 

By nephrotomy is meant the cutting into a kidney. Indi- 
cation, renal calculus. 

By nephrectomy is meant the excision of a kidney. Indi- 
cation, a primary malignant renal growth. 

Name the methods of inflating the tympanum. 

Valsalva's, Politzer's, and by means of the Eustachian 
catheter. 

What are the conditions which render excision of the 
lower jaw advisable? 

Malignant tumors of the mandible, malignant tumors in 
the adjacent tissues involving the bone secondarily, trau- 
matism, and necrosis may render excision advisable. 

What are the complications of dislocation of the hip? 

Fracture of the acetabulum (with or without injury to the 
pelvic viscera), fracture of some portion of the upper ex- 
tremity of the femur, rupture of the femoral artery, paralysis 
from compression or rupture of a nerve-trunk, and extensive 
laceration of the neighboring soft parts. 

What arteries need ligating in amputation at the middle 
third of the leg? Describe your method of ligating. 

The anterior tibial, the posterior tibial, and the peroneal. 
The anterior tibial artery will be found just above the inter- 
osseous membrane lying between the tibialis anticus and the 
extensor proprius hallucis. The artery should be freed from 
the surrounding structures and ligated separately or to- 
gether with the two venae comites, care being taken not to 
include the anterior tibial nerve. If the artery cannot be 
reached owing to excessive retraction, the patient should be 
turned on his face, when the weight of the stump will extend 
the limb and make the vessel much easier of access. The pos- 
terior tibial will be found behind the tibia lying upon the 
flexor longus digitorum or between it and the tibialis pos- 
ticus. It should be freed from surrounding structures and 
ligated separately or together with its two venae comites; 
care must be taken not to include the posterior tibial nerve. 



268 SURGERY. 

The peroneal artery will be found behind the fibula between 
the tibialis posticus and flexor longus hallucis or surrounded 
by the fibres of the flexor longus hallucis. It should be freed 
from surrounding structures and ligated separately or to- 
gether with its two venae comites. Both the posterior tibial 
and the peroneal arteries will be found anterior to the deep 
transverse fascia of the leg. After these three arteries have 
been secured, the tourinquet should be loosened and any other 
bleeding point seized and tied. 

Where may a ligature be applied for aneurysm of the 
popliteal artery? 

Preferably at the apex of Scarpa's triangle or in Hunter's 
canal. It may also be applied in the upper portion of the 
popliteal space, just after the passage of the artery through 
the opening in the adductor magnus. 

What are the indications for litholapaxy (rapid Iitho= 
trity) as compared with (a) lateral perineal lithotomy; (b) 
median perineal lithotomy; (c) suprapubic lithotomy? 

Unless some contra-indication exists litholapaxy is the 
operation par excellence. The contra-indications are : 1. 
Encysted calculus (absolute contra-indication) ; 2. A stone 
larger than 1% inches in diameter, though many surgeons 
will crush much larger stones ; 3. Stones consisting of calcium 
oxalate are so hard that the crushing operation is difficult 
and sometimes impossible; 4. Excessive irritability of the 
urethra; 5. Urethral stricture of old standing not capable of 
dilatation or the existence of false passages; 6. Cystitis; 7. 
Enlarged prostate; 8. Sacculated or contracted bladder (hold- 
ing less than six ounces) ; 9. Extensive renal disease (unless 
there is no doubt that the operation may be quickly per- 
formed) . 

Lateral perineal lithotomy is indicated: 1. Where cystitis 
and great irritability of the bladder are present; 2. In phos- 
phatic concretions ; 3. If the bladder is contracted. 

Median perineal lithotomy is rarely performed, as the open- 
ing is much smaller than in the lateral operation. The 



SURGERY. 269 

advantages claimed for it are the small amount of hemor- 
rhage and the lessened danger of urinary infiltration and 
injury to the ejaculatory ducts. 

Suprapubic lithotomy is to be performed : 1. When the 
stone is too large to crush; 2. If the stone is encysted; 3. If 
old strictures or an enlarged prostate is present ; 4. When the 
patient cannot assume the lithotomy position (ankylosis of 
left hip, rachitic contraction of pelvis, presence of a tumor) ; 
5. When the crushing operation is not deemed advisable in 
young boys. 

The indications for the suprapubic operation have been 
greatly extended in recent years at the expense of the perineal 
method. The only two absolute contra-indications to the 
procedure are severe septic cystitis and contraction of the 
bladder. 

What fractures do not present mobility? Under what 
circumstances is crepitus absent? 

Impacted fractures and incomplete fractures do not present 
preternatural mobility. 

Crepitus is absent in impacted fractures, in incomplete 
fractures where there is great separation or over-riding of 
the fragments, and where portions of muscle, tendon, or peri- 
osteum are between the fragments. 

What symptoms follow division of the radial nerve? 

Anesthesia over the radial side of the dorsal surface of the 
wrist and hand and over the dorsal surface of the thumb, 
index, middle, and radial half of ring fingers, excepting over 
the terminal phalanges. 

What conditions of the kidneys require nephrectomy? 

Any of the following conditions may require nephrectomy : 
Carcinoma, sarcoma, tuberculosis, calculous pyonephrosis, 
hydronephrosis, traumatic lesions (particularly if compli- 
cated by laceration of the peritoneum), and some cases of 
ruptured ureter. 



270 SURGERY. 

How may a quart of normal salt solution be prepared at 
the patient's home? 

By dissolving two teaspoonfuls of salt in a quart of water. 
The solution may be sterilized by boiling. The percentage of 
salt is not accurate, but it is near enough for practical pur- 
poses. 

What are the principal affections of synovial bursae? 

Acute simple bursitis, acute suppurative bursitis, chronic 
fibroid bursitis, chronic bursitis with effusion (house-maid's 
knee), chronic tuberculous bursitis, syphilitic, and gouty de- 
posits. 

What muscles are divided in the operation for (a) di= 
verging strabismus, (b) converging strabismus? 

(a) The external rectus, (b) The internal rectus. 

How would you reduce a dislocation of the inferior 
maxillary bone? 

It is only necessary to depress the condyle below the level 
of the eminentia articularis, when the masseter, temporal and 
internal pterygoid muscles will readily draw it back into the 
glenoid cavity. The patient is to be seated, the surgeon 
stands in front of the patient and presses down upon the 
molar teeth with his two thumbs, which are guarded by a 
towel. This pressure is continued in a downward and back- 
ward direction until the condyle clears the eminentia articu- 
laris, when the chin is to be raised by the fingers. The jaw 
should be kept at rest for four or five days by a Barton 
bandage. 

Name the varieties of shoulder=joint dislocations. 

Anterior (subcoracoid, intracoracoid, subclavicular), down- 
ward (subglenoid, erecta), posterior (subacromial, subspi- 
nous), and upward (supraglenoid). 

What are the possible mechanical obstructions in the 
reduction of fractures? 

Muscular spasm, the interposition of muscle or periosteum 






SURGERY. 271 

between the ends of the fragments, impaction of the frag- 
ments, perforation of the skin by one of the fragments, and 
effusion into a joint (in fracture of patella or of olecranon). 

What are the sources of wound infection? 

A wound may be infected by the foreign body making the 
wound, by any foreign substance or fluid coming in contact 
with the wound, by the blood, by the skin of the patient, by 
the hands of the surgeon and assistants, and by instruments, 
ligatures, sutures or dressings. Aerial infection is very rare, 
though possible. 

Relate the difference between a sinus and a fistula. 

A sinus is an abnormal canal leading from the skin or 
mucous membrane to an abnormal cavity. It has but one 
opening. 

A fistula is an abnormal communication between the skin 
or mucous membrane and a normal cavity. It has two open- 
ings. 

Define pyemia and give its symptoms. 

By pyemia is meant a general infection of the blood with 
pyogenic organisms. It is septicemia plus metastatic ab- 
scesses. 

Symptoms : Repeated rigors with a markedly remittent 
temperature, exhausting diaphoresis, hyperesthesia of the 
■skin, suppuration in joints not usually involved in other 
febrile affections (sterno-clavicular, sacro-iliac), and diar- 
rhea. If there is an open wound it will become dry and 
glazed. Physical examination will reveal the signs of pulmo- 
nary congestion or pneumonia, metastatic abscesses may be 
detected in various portions of the body, and examinations 
of the blood show a leukocytosis. The mind is usually clear. 
Toward the termination of the affection the patient may fall 
into the typhoid state. 

What are the indications for castration? 

Castration may be performed for malposition, for tuber- 
culous disease, for old standing hematoceles, for simple or 



272 SURGERY. 

malignant tumors, after some injuries, and for chronic en- 
largement of the prostate. 

Give the causes and sequelae of suppurative middle ear 
disease. 

Causes: Inflammations in the naso-pharynx and infected 
wounds of the membrana tympani. 

Sequelae: These may be divided into the extracranial, cra- 
nial and intracranial. 

Extracranial: Eczema of meatus, furuncles of meatus, sub- 
periosteal abscess and necrosis of tympanic plate. 

Cranial : Necrosis of ossicles, caries or necrosis of temporal 
bone, polypi, facial paralysis and mastoiditis. 

Intracranial : Extradural abscess, localized or diffused men- 
ingitis, thrombosis of the lateral sinus, and cerebral or cere- 
bellar abscess. Remember that 50 per cent, of all cases of 
brain abscess are due to this cause. 

State the causes of exophthalmos. 

Paralysis of the third cranial nerve, intra-orbital aneurysm, 
intra-orbital tumors, thrombosis of cavernous sinus, fracture 
of anterior fossa with laceration of cavernous sinus, em- 
pyema of the antrum, tumors of the antrum, and exoph- 
thalmic goitre. 

What are gliomata and where are they found? 

Gliomata are tumors composed of neuroglia. They occur in 
the brain, spinal cord, and rarely in the cranial nerves. The 
so-called glioma of the eye-ball is really a sarcoma. 

Mention obstacles to reduction of dislocations. 

Muscular resistance, anatomical peculiarities of the joint, 
the interposition of shreds of the capsular ligament, fracture 
of the bone involved, and the presence of adhesions (old dis- 
locations). 

Define torticollis. Give the differential diagnosis of 
torticollis and cervical caries. 

Torticollis or wry-neck is a deformity due to contraction of 



SURGERY. 272 

certain muscles on one side of the neck. The sterno-mastoid 
is first affected, but the trapezius, the splenius, the platysma,. 
and even the cervical fascia may be involved. 

In cervical caries motion in all directions is restricted, and 
pain is elicited by pressing upon the cervical vertebrae; in 
torticollis motion is restricted in but one direction, that in 
which the muscle involved is put upon the stretch. 

Describe hypospadias, epispadias, phimosis, and para= 
phimosis. 

Hypospadias is a malformation in which the urethra opens 
upon the under surface of the penis. 

Epispadias is a malformation in which the urethra is par- 
tially or wholly exposed on the upper surface of the penis. 

Phimosis is that condition in which the prepuce is elon- 
gated, and in which the preputial orifice is so narrow that it 
can not be retracted behind the corona glandis. 

By paraphimosis is meant a strangulation of the glans penis 
by a prepuce which has been forcibly retracted and cannot be 
replaced. 

What is genu valgum? State how genu valgum shojld 
be treated. 

Genu valgum or knock-knee is a deformity in which there 
is an abduction of the legs from the median line, together 
with a certain amount of external rotation. The two inner 
condyles may be brought into apposition, while the two inter- 
nal malleoli are separated. Young children (up to the fifth 
or sixth year) in whom the deformity is not great may be 
treated by mechanical appliances. If due to rickets appro- 
priate constitutional treatment must be observed. When the 
deformity is great and the age of the patient precludes the 
hope of a cure by mechanical means, osteotomy is indicated. 
The best method of performing osteotomy' is that of Macewen. 

What are the symptoms when the ulnar nerve has been 
divided on a level with the pisiform bone? 

Loss of adduction and abduction of the fingers, flexion of 
the last two phalanges of each finger, and hyper-extension at 

18 



274 SURGERY. 

the metacarpophalangeal joint ("claw-hand"). The inter- 
osseous spaces become very marked from the atrophy of the 
muscles involved (the two inner lumbricales and all of the 
interossei). There is also a paralysis of the short muscles 
of the little finger, of some of the thumb muscles (adductor 
transversus, adductor obliquus, and part of flexor brevis pol- 
licis), and of the palmaris brevis. There is anesthesia of the 
ulnar side of the dorsum and palm of the hand, and of both 
dorsal and palmar surfaces of the little and ulnar side of the 
ring fingers. 

What tissues are divided in the operation for oblique 
inguinal hernia? 

.Skin, superficial fascia, intercolumnar fascia, cremaster 
muscle, infundibuliform fascia, subserous areolar tissue, and 
parietal peritoneum. The superficial epigastric and the 
superficial external pudic arteries are always divided. 

What are the indications for the operation of gastro= 
stomy? 

Malignant disease of the esophagus and stricture or stenosis 
of the esophagus from any cause, when the patient is unable 
to take sufficient nourishment. 

What is the differential diagnosis between septicemia 
and pyemia? 

Septicemia occurs before the advent of suppuration, re- 
peated rigors and metastatic abscesses are absent, and the 
patient is delirious. 

Pyemia occurs after the advent of suppuration, repeated 
rigors and metastatic abscesses are present, and delirium, if 
present at all, is apt to be nocturnal. 

A differential diagnosis is frequently impossible, but the- 
oretically the points given above are those to be expected. 

Give the differential diagnosis between sacroiliac dis= 
ease and morbus coxarius. 

In sacro-iliac disease pressure upon the crests of the ilia 
causes pain; if the pelvis be supported, the thigh may be 



SURGERY. 275 

moved in all directions without much discomfort; apparent 
or real shortening of the lower extremity is never present. 

In morbus coxarius pressure upon the crests of the ilia 
produces no pain; motion of the thigh is accompanied by 
pain; apparent or real shortening of the lower extremity is 
always present at some stage of the affection. 

What are the principal affections of muscles? 

Contusion, sprain, rupture of sheath, rupture of muscle or 
tendon, displacement of tendon, myositis (traumatic, rheu- 
matic, acute suppurative, tubercular, syphilitic, parasitic, and 
myositis ossificians), primary tumors (angioma, fibroma, 
chondroma, myxoma, and sarcoma), and secondary tumors 
(carcinoma and sarcoma). 

Give the indications and methods for ligature of the 
common carotid artery. 

The common carotid artery is tied for aneurysm, for wounds 
of the internal or external carotid artery or their branches, 
to check malignant growths, and as a preparatory procedure 
to the removal of tumors. 

Ligation in superior carotid triangle. The patient should 
be on his back with his shoulder elevated, the head thrown 
back, and the face turned slightly to the opposite side. After 
all aseptic precautions have been carried out an incision three 
inches in length is made in the line of the artery (from the 
sterno-clavicular articulation to a point midway between the 
angle of the jaw and the mastoid process), the center of the 
incision being opposite the cricoid cartilage. The skin, super- 
ficial fascia, platysma myoides, and superficial layer of the 
deep fascia are to be divided, the sterno-mastoid muscle drawn 
outward, the tendon of the omo-hyoid drawn downward, and 
the pulsations of the artery sought for beneath the sterno- 
mastoid. The sheath is now opened upon the inner side, the 
aneurysm needle is passed from without inward, threaded, 
and withdrawn. 

Ligation in inferior carotid triangle. Patient in same 
position as before. The incision is made in the line of the 



276 SURGERY. 

artery from the level of the cricoid cartilage to the sterno- 
clavicular articulation, and divides skin, superficial fascia, 
platysma, and superficial vessels and nerves. The superficial 
layer of the deep cervical fascia is then divided, the sterno- 
mastoid muscle drawn outward, and the sterno-hyoid and 
sterno-thyroid muscles drawn inward. The sheath is opened 
upon the inner side, and the aneurysm needle passed from 
without inward. 

What operations are performed for intractable neural= 
gia of the fifth nerve? 

Neurotomy, nerve stretching, removal of Meckel's ganglion, 
neurectomy, and removal of the Gasserian ganglion. Accord- 
ing to the symptoms, one or more of the following nerves may 
be resected: Supra-orbital, supra-trochlear, infra-orbital, in- 
ferior maxillary division of the fifth, lingual, inferior dental, 
and mental. 

State the most common seat of fracture of the clavicle 
and describe a method of treatment. 

At the outer end of the middle third of the bone. 

Sayre 's method. Three strips of adhesive plaster three and 
one-half inches wide and long enough to encircle the chest and 
arm are required. A loop is made in the end of the first strip ; 
this loop is secured by stitches and made to encircle the arm 
close to the axilla, the non-adhesive surface of the plaster 
being next to the skin. The shoulder is then drawn backwards 
and the adhesive strip carried around the chest from behind 
forward (adhesive surface next to skin), passing over the 
front of the chest, under the axilla, and finally attached to the 
part crossing the back. The elbow of the injured side is now 
brought forward and the hand placed upon the sound shoul- 
der. As the loop of the first strip acts as a fulcrum, the shoul- 
der and outer extremity of the clavicle are carried backward. 
With the arm in this position the end of the second strip is 
fixed to the sound shoulder, and the strip is then brought 
downwards across the back to the elbow of the injured side 
(a hole being cut in the plaster to accommodate the olecra- 



SURGERY. 277 

non), upwards across the front of the chest and forearm, and 
fastened to the other end over the top of the sound shoulder. 
This strip holds the shoulder back and keeps it raised. The 
third strip is passed horizontally about the chest and forearm 
to hold the extremity against the body. A towel should be 
placed in the axilla, and all contiguous cutaneous surfaces 
should be separated by pieces of lint. This position is to be 
maintained until union occurs (about three or four weeks), 
and the movements of the arm should be restricted for a week 
or so longer. 

Describe atrophy and give the causes. 

Atrophy is a reduction in bulk of one or more of the com- 
ponent parts of an organ, with a reduction of functional 
activity. 

Causes: 1. Diminished functional activity; 2. Defective 
nutrition; 3. Pressure; 4. Nervous influence (neuropathic 
atrophy) ; 5. Senility. 

What symptoms foliow division of the facial nerve? 

Paralysis of the same side of the face without implication 
of palate or uvula (it is presumed that the nerve has been 
divided after its exit from the skull) . The paralyzed side of 
the face is immobile, devoid of expression, and the natural 
folds and wrinkles are obscured. The eye-lids cannot be 
completely closed, the eye-ball rolling upward and outward 
when forcible closure is attempted. Epiphora is present 
from the drooping of the lower lid. The lips cannot be 
firmly closed, and whistling is impossible. If attempts are 
made to move the face (to show the teeth or laugh) marked 
asymmetry is produced, the face being drawn toward the 
non-paralyzed side. Owing to the paralysis of the bucci- 
nator, food collects between the teeth and the cheek. 

What method of treatment affords the most prompt 
relief in paronychia? 

Evacuation of the pus or inflammatory exudate by means 
of an incision, the introduction of a small strip of iodoform 



278 SURGERY. 

gauze for drainage, and the application of a moist antiseptic 
dressing. 

Describe the operation for ligature of the subclavian 
artery in its second part. 

The patient should be in the dorsal position, with a cushion 
beneath the shoulders, face turned to the opposite side, and 
the shoulder depressed. After all aseptic precautions have 
been carried out, the skin should be drawn down over the 
clavicle, and an incision made over the bone extending from 
the middle of the clavicle almost to the sterno-clavicular 
articulation. The skin is then allowed to retract, and the 
wound will be half an inch above the clavicle. This incision 
divides the skin, superficial fascia, platysma myoides, and the 
superficial layer of the deep cervical fascia. The clavicular 
head of the sterno-mastoid muscle should then be divided, 
and any veins overlying the prevertebral fascia covering the 
scalenus anticus ligated. The prevertebral fascia is then 
incised, the phrenic nerve drawn inward, and the outer two- 
thirds of the anterior scalene muscle divided close to its 
attachment to the first rib. Care must be taken not to wound 
the anterior jugular, external jugular, internal jugular or 
subclavian veins, the phrenic nerve or the pleura. The needle 
is passed from before backward and from below upward. 

What are the varieties of ankylosis? 

Incomplete or fibrous and complete or bony. Ankylosis is 
also spoken of as being either true (involvement of articular 
structures) or false (result of extra-articular lesions). 

When is operative interference advisable in the treat= 
ment of malignant tumors? 

Operative interference is advisable when the tumor can be 
thoroughly removed, when the operation will diminish pain 
or make the patient more comfortable, and when it will 
lengthen the life of the patient. 

Define peritonitis. State three ways in which the peri= 
toneum may be invaded by bacteria. 

By peritonitis is meant an inflammation of the peritoneum. 



SURGERY. 279 

Bacteria may invade the peritoneum through the Avail of the 
intestine, through a wound in the abdominal wall, or through 
a perforating ulcer of the stomach. 

What is the treatment for stenosis of the lachrymal 
duct? 

Dilatation by means of lachrymal probes. The passage of 
the larger probes is preceded by division of the lower canali- 
culus. If the stenosis is simply due to tumefaction of the 
mucous membrane (as in the new-born) it may yield to 
medicinal agents. 

What are the causes of ischiorectal abscess? 

Infection of the ischio-rectal areolar tissue with pyogenic 
organisms from the perineum or rectum, injuries to the peri- 
neum or rectum, and exposure to cold or wet. Suppuration 
in the ischio-rectal fossa may also be due to disease of adja- 
cent or distant structures (sacro-iliac or hip joints, pelvic 
bones, spine, prostate) . 

Give an operation for excision of the tongue for car- 
cinoma. 

Kocher's operation. After all aseptic precautions have 
been carried out, tracheotomy is performed, a well-fitting 
canula is introduced, and the pharynx packed with a carbol- 
ized sponge which has a cord attached to it. The incision 
commences near the lobule of the ear, passes down the ante- 
rior border of the sterno-mastoid muscle to its middle, along 
the hyoid bone to near the median line, and then upwards to 
the symphysis. This flap of skin and subcutaneous tissue is 
dissected up and held out of the way by a retractor. All the 
lymphatic glands in the submaxillary triangle are removed, 
as well as the submaxillary (and if necessary the sublingual) 
salivary gland, and the facial and lingual arteries are ligated 
close to the carotid. If any portion of the mandible is dis- 
eased it may be removed by enlarging the wound. The oppo- 
site lingual artery is now tied through a separate incision. 
The mylo-hyoid muscle and the reflection of the oral mucous 
membrane are then divided close to the alveolus, the tongue is 



280 SURGERY. 

drawn out through the wound and removed close to the epi- 
glottis behind and close to the hyoid bone below. The entire 
raw surface is now painted with Whitehead's varnish, the 
external incision is closed by sutures, excepting the lower- 
most portion, in which a drainage. tube is inserted, an aseptic 
dressing is applied, and the sponge in the pharynx is replaced 
by gauze packing. 

How should ankylosis of the jaw be treated? 

By division of the neck of condyle, by excision of condyle, 
removal of the vertical ramus as far as the alveolar border, or 
by the excision of a wedge of bone (apex toward alveolar 
border) from the neighborhood of the angle, and the estab- 
lishment of an artificial joint in this situation (Esmarch's 
operation) . Excision of the condyle and Esmarch's operation 
are the measures usually employed. 

How should hemorrhage from the liver, occurring in the 
course of an operation, be controlled? 

By tamponing with iodoform gauze, by the thermo-cautery, 
by ligature, and by suture. 

Describe Pott's fracture of the lower extremity. 

By Pott's fracture is meant a fracture of the fibula about, 
three inches above the tip of the malleolus. Dependent upon 
the amount of violence, there may co-exist one or more of the 
following lesions : 1. Rupture of the internal lateral ligament ; 
2. Tearing off of the internal malleolus ; 3. Fracture of the 
external portion of the articular surface of the tibia. The 
foot is practically always everted, and shows a tendency to 
slip backward. There are points of tenderness over the lines 
of fracture, the foot may be moved from side to side in the 
widened tibio-fibular mortise, and crepitus may be obtained. 

Give the general symptoms of brain tumor. 

Headache, pain upon percussion, vomiting, vertigo, epi- 
leptic convulsions, choked disc, and finally symptoms of com- 
p: ession. 



SURGERY. 281 

Describe an operation for the cure of webbed fingers. 

Didot's operation. After all aseptic precautions have been 
observed, a flap the length of the finger and half its width 
(plus the added width of the web) is taken from the dorsal 
surface of one finger and the palmar surface of the other. 
Each of these flaps is carefully applied to the denuded area 
upon the finger to which it is attached and secured by sutures. 

How is resection of the elbow joint performed? 

After all aseptic precautions have been observed, the fore- 
arm is flexed to a right angle and held across the chest of the 
patient by an assistant. A vertical incision five inches in 
length is now made along the back of the joint, the center of 
the incision being a line or two to the inner side of the tip of 
the olecranon. This incision goes down to the bone and di- 
vides the tendon of the triceps longitudinally. The tendon 
is then separated from the olecranon and this process cleared 
off, keeping the knife close to the bone to avoid wounding the 
ulnar nerve on the inner side and the extension of the triceps 
upon the outer side. The olecranon is now cut through and 
removed. With the thumb in the wound to protect the soft 
parts, the structures are gradually separated from the internal 
condyle by the knife (cutting towards the bone) or periosteal 
elevator. In this manner the common flexor tendon is sepa- 
rated from the bone and the internal lateral ligament is di- 
vided. The external condyle is. now freed in a similar man- 
ner, and the end of the humerus is protruded through the 
wound by flexing the forearm until it touches the arm. The 
articular surface of the humerus is now sawn off. and if any 
carious areas are seen upon the surface of section they are to 
be thoroughly gouged out. The bones of the forearm are then 
forced through the wound and their cartilaginous surfaces 
removed. Care must be taken not to injure the insertions of 
the biceps and brachialis anticus. All diseased synovial mem- 
brane and granulation tissue must be dissected away, any ex- 
isting sinuses thoroughly curetted, and the parts flushed with 
an antiseptic solution. A drainage tube is inserted in the 
most dependent portion of the wound, sutures are introduced, 
and an aseptic dressing applied. 



282 SURGERY. 

Give the symptoms and treatment of naevus. 

Capillary naevus occurs in the form of a slightly elevated 
mass, which varies in color from purple to bright red, ac- 
cording to the relative amount of contained venous or arte- 
rial blood. These growths are congenital or occur soon after 
birth, they may be multiple, and rarely exceed an inch or two 
in diameter. They are usually found upon the neck or face. 
They may shrink and disappear, persist unchanged, or rapidly 
increase in size. Treatment: Excision or electrolysis. 

Cavernous naevus usually involves both skin and subcuta- 
neous connective tissue. It usually occurs as a lobulated 
bluish or dusky red swelling, soft to the touch, easily com- 
pressible, but refilling upon the removal of the pressure. 
Pulsation and bruit are usually absent. Treatment : Excision 
wherever practicable. Electrolysis when the growth cannot 
be excised. 

What is glaucoma? Give the treatment of glaucoma. 

Glaucoma is a disease of the eye characterized by increased 
intra-ocular tension, excavation of the optic disc, restriction 
of the field of vision, corneal anesthesia, colored halos about 
lights, and a diminution of visual power that may result in 
blindness. Treatment: Iridectomy. 

What is a tumor? 

A tumor is an atypical new growth which is not the result 
of inflammation. 

A tumor is an adventitious mass of tissue, differing from 
the tissue in which it grows in gross and minute structure, 
tending to unlimited growth, having no function, the nutri- 
tion of which is independent of the general nutrition of the 
body, showing no tendency to spontaneous cure, and not co- 
incident with nor dependent upon inflammation. 

Describe the following forms of sutures: Interrupted, 
button, continued, buried, secondary. 

The interrupted suture consists of a number of single 
stitches, each one being independent of its neighbor. 



SURGERY. 283 

The button suture is made by inserting a needle threaded 
with stout silver wire at some distance from the wound, carry- 
ing it deeply through the tissues and bringing it out at a cor- 
responding point on the opposite side of the wound. The 
suture is secured at both ends to a flat lead button, the wire 
being pulled as tight as is deemed advisable. 

In a continued suture the suture traverses the wound con- 
tinuously in the same direction, being tied only at the begin- 
ning and at the end. 

A buried suture is one completely covered by and not in- 
volving the skin. 

Secondary sutures are those which are introduced at some 
time (usually two or three days) subsequent to an operation. 

What are the causes of atony of the bladder? 

Chronic over-distension from obstructed outflow (enlarged 
prostate, stricture), a single prolonged voluntary or involun- 
tary over-distension, cystitis (particularly when gonorrheal), 
senility, and infective fevers. 

What is the treatment of fracture united with deformity? 

Osteotomy or osteoclasis. If the deformity is not great no 
treatment may be required. 

Give the treatment for rattlesnake bite. 

If the bite has been received upon a limb, a ligature should 
be immediately thrown around the part above the wound and 
drawn tight enough to prevent the entrance of the venom 
into the circulation. The wounded area should then be freely 
excised and bleeding encouraged for a short time. If the 
bite is upon a portion of the body which cannot be constricted 
by a ligature the wound should be excised as before, or if this 
is impracticable vigorous suction of the wound should be 
made. In the case of an extremity the ligature is to be slack- 
ened at intervals to allow of the admission of any remaining 
poison by instalments. The injection about the wound of a 
1 per cent, aqueous solution of potassium permanganate has 
been highly recommended. Antivenene may also be em- 



284 SURGERY. 

ployed. The constitutional treatment consists of the free 
administration of alcohol and hypodermatic injections of 
strychnine. 

What circumstances demand amputation of an ex= 
tremity? 

Amputation is demanded : 1. To trim up a stump of a limb 
torn off by machinery, cut off by wheels of a railway train, 
or carried away by a cannon-ball; 2. When the entire limb or 
one of its segments has been totally disorganized; 3. Where 
gangrene is imminent or has supervened (particularly if it is 
of the spreading type) ; 4. When marked symptoms of sepsis 
make their appearance or exhaustion supervenes from sup- 
puration, in a case where an unsuccessful attempt has been 
made to save a doubtful limb ; 5. In severe compound lacera- 
tions of the foot in old people, laying open the common syn- 
ovial cavity and involving the, bones; 6. By primary malig- 
nant growths of bone (sarcoma). 

Amputation may be required for the relief of deformity, 
for the removal of benign growths (enchondroma of fingers), 
for laceration of the main artery of the limb, with other grave 
lesions of the soft parts, and in cases where the limb, if saved, 
would be of no practical use. 

Define the terms thrombus, phlebitis, and varix and give 
the causes of each. 

A thrombus is a clot of blood formed within the heart or 
blood-vessels. It is due to alterations in the blood current, 
changes in the vessel- walls, and alterations in the blood itself. 

By phlebitis is meant the inflammation of a vein. It may 
be due to injury of the coat of the vein, to the formation of a 
thrombus within the vein, to- the extension of an inflammation 
from surrounding tissues, to gout, or to infection with pyo- 
genic organisms. 

By varix is meant a dilated, elongated, and more or less 
tortuous condition of a vein. It is due to increased pressure 
within the veins (long standing, habitual over-exertion, tight 
garters), obstruction or occlusion of the deeper veins, and to 



SURGERY. 285 

an abnormal communication with an artery (aneurysmal 
varix). Inherited weakness and the relaxation of the system 
from sedentary habits are predisposing causes. 

Describe a chancroid. Give its usual symptoms and 
possible complications. 

A chancroid is an infectious venereal sore characterized by 
the absence of constitutional manifestations. , It commences 
as a pustule or ulcer, is frequently multiple, is round, oval, 
or unsymmetrically irregular, is excavated or ' ' punched out, ' ' 
has a rough "worm-eaten" whitish- gray surface, secretes an 
abundant purulent discharge which is readily auto-inoculable, 
runs an irregular course, is painful, and usually responds to 
local treatment. The possible complications are phimosis, 
paraphimosis, lymphangitis, and bubo. 

What is a dislocation? Define the various kinds of 
dislocation. 

A dislocation is a displacement of one or more bones of a 
joint from its natural position. It is also the displacement 
of any organ from its natural position. 

Traumatic, due to violence or muscular action. 

Pathologic, due to disease. 

Congenital, due to an error of development, as a result of 
which a normal relation of the bony constituents has never 
existed. (The term "congenital dislocation" is a misnomer; 
it is a congenital malformation. ) 

What are the methods of controlling hemorrhage? 

Exposure to air, cold, hot water, elevation, direct pressure, 
styptics, cauterization, acupressure, forcipressure, suture, 
torsion, and ligation. 

Define hypertrophy and give the causes. 

Hypertrophy is an increase in bulk of a tissue or organ 
occurring independently of the general growth of the body 
and without any structural change of the part affected. In 
a true hypertrophy the function is increased. 

Causes: Congenital predisposition, removal of pressure, 



286 SURGERY. 

direct stimulation or intermittent pressure, disturbances of 
nutrition, increased functional demand, and disturbances of 
the nervous system. 

Give the surgical palliative treatment of carcinoma of 
the stomach at the pylorus. 

Gastro-enterostomy, preferably by Yon Hacker's method 
(posterior gastro-enterostomy). 

Mention the causes of delayed union and give the treat= 
ment. 

The constitutional causes are general debility, osteomalacia, 
scurvy, syphilis, senility (?), pregnancy, and the cancerous 
cachexia. 

The local causes are faulty apposition, the interposition of 
fluid, muscle, or aponeurosis between the fragments, want of 
rest, defective blood supply, defective innervation, inflamma- 
tion on the surface of the limb, faulty treatment, and local 
affections of bone (malignant tumors, destruction of the peri- 
osteum by inflammation) . 

Treatment : The removal of any local cause and the appro- 
priate remedies for the underlying constitutional disturbance. 
Change of air, tonics, regulation of the diet, and the adminis- 
tration of the mineral acids will frequently effect a speedy 
union. 

What glandular structures are most commonly affected 
in carcinoma of the anterior portion of the tongue? 

The submental lymphatic glands, the submaxillary lym- 
phatic glands, and probably those lying beneath the sterno- 
mastoid muscle. The sublingual and submaxillary salivary 
glands may also be involved. 

What are the causes of ptosis and the remedial meas=» 
ures employed? 

Paralysis of the oculo-motor nerve or its supra-orbital 
branch (syphilis, rheumatism), and faulty development or 
injury of the levator palpebrae. 

Treatment: If due to syphilis or rheumatism the appro- 



SURGERY. 287 

priate constitutional treatment is to be instituted. In the 
absence of constitutional causes, operations are performed to 
increase the vicarious action of the frontalis muscle upon the 
upper lid (Panas) . Wilder folds the tarso-orbital fascia upon 
itself and establishes a firm adhesion between the fascia and 
the frontalis muscle. If the action of the levator muscle is 
not entirely lost the principles of tendon advancement and 
tendon resection may be employed. (Eversbusch, Snellen, 
Wolff.) 

What articular changes take place in dislocation? 
What are the general principles governing the treatment 
of dislocation? 

One or more of the ligaments and the capsule of the joint 
are torn and the mutual relations of the articular ends of the 
bones are changed. If the dislocation remains unreduced 
the cavity of the joint becomes filled with granulation tissue 
and the displaced and lacerated connective tissues become 
condensed about the head of the dislocated bone, sometimes 
forming a new capsule. Any irregularities of the dislocated 
bone become rounded off and it contracts adhesions to the 
surrounding tissues or forms a new joint by resting against 
a bony surface, its pressure stimulating the bone and peri- 
osteum to the production of an osseous ring about the point of 
contact, which possibly becomes covered with fibro-cartilage. 

Principles of treatment : Relaxation of the muscles about 
the joint, the reduction of the dislocation by causing the dislo- 
cated bone to enter the capsule through the same rent which 
it made upon leaving it (by manipulation, or by extension 
and counter-extension), the fixation of the parts after reduc- 
tion for a sufficient length of time, and subsequent passive 
and active motion. 

Define a fracture. Give the causes, symptoms, and 
varieties of fracture. 

A fracture is a sudden solution of continuity of a bone. 
Predisposing causes : Advancing age, male sex, and diseased 



288 SURGERY. 

conditions of the bone (atrophy, fragilitas ossium, rickets, 
sarcoma, secondary cancer). 

Exciting causes: Direct violence, indirect violence, and 
muscular action. 

Symptoms: A new point of motion (preternatural mobil- 
ity) , crepitus, deformity from displacement, partial or com- 
plete loss of function, and signs of local trauma. 

Varieties: Complete and incomplete. Simple (subcutan- 
eous), compound (open), single, multiple, complicated, com- 
minuted, and impacted. Linear, stellate, longitudinal, 
transverse, and spiral. 

What diseases attack the antrum maxillae (Highmore)? 

Hydrops, empyema, benign tumors (chondroma, fibroma, 
myxoma, osteoma), and malignant tumors (sarcoma and 
carcinoma) . 

When do the secondary symptoms of syphilis normally 
appear? What are these symptoms? When do the ter= 
tiary symptoms appear? 

The secondary symptoms of syphilis normally appear from 
six to ten weeks after the beginning of the infecting chancre. 
The secondary symptoms are syphilis of skin and mucous 
membranes (mucous patches, roseola, papules, pustules, etc.), 
fever, general enlargement of the lymphatic glands, sore 
throat, and alopecia. 

Tertiary symptoms may appear within six months of in- 
fection or not for twenty or thirty years. The time of their 
appearance is largely dependent upon the treatment received 
by the patient. In some cases which have been correctly 
treated they may never make their appearance. 

Give a resume of the constitutional and the local treat= 
ment of inflammation. 

Constitutional treatment : Rest, good hygiene, proper diet, 
purgatives, emetics, arterial sedatives, diaphoretics, diuretics, 
venesection, hypnotics, narcotics, alteratives, stimulants, and 
tonics. 



SURGERY. 289 

Local treatment : Rest, position, heat, cold, counter-irritation, 
local blood-letting (scarifications, leeches, wet cups), moisture, 
stimulants, astringents, antiseptics, alteratives, incisions, sur- 
gical operations, compression, and massage. 

Differentially diagnose chancre, chancroid, and herpes 
progenitalis. 

Chancre has a period of incubation not less than ten days; 
commences as an erosion, tubercle, papule, or ulcer ; is single, 
or simultaneously multiple; is round, oval, or symmetrically 
irregular; is usually cup-shaped, saucer-shaped, or elevated; 
has a smooth shining red or glazed surface, and may be cov- 
ered by a diphtheritic membrane or scab ; has a scanty, serous 
secretion which is practically never auto-inoculable ; is almost 
always indurated (cartilaginous or parchment-like), the in- 
duration being circumscribed and disappearing under appro- 
priate treatment; is accompanied by little or no pain, and 
often heals spontaneously. 

Chancroid has no period of incubation; commences as a 
pustule or ulcer; is often multiple (frequently by auto- 
inoculation) ; is round, oval, or unsymmetrically irregular 
(with borders described by segments of large circles) ; is 
hollow, excavated, or punched out; has a rough, "worm- 
eaten," whitish-gray surface; has an abundant, muco-puru- 
lent secretion (readily auto-inoculable) ; is only exceptionally 
indurated (induration shades off into surrounding tissues) ; 
is painful, and runs an irregular course. 

Herpes progenitalis has no period of incubation, commences 
as a group of vesicles which may coalesce; is multiple, is 
irregular in shape (edges described by segments of small 
circles), is always superficial, has a moderate amount of 
secretion (auto-inoculable with difficulty), has no more in- 
duration than any local ulcer, is painful, and usually heals 
promptly under mild local treatment. (Condensed from 
Keen and White. ) 

How would you diagnose and reduce a backward dislo= 
cation of the forearm? 

The forearm is shortened, semiflexed, and midway between 
19 



290 SURGERY. 

pronation and supination. The forearm cannot be flexed 
upon the arm. The olecranon is unduly prominent behind 
the joint, and above it is a depression in which the tendon 
of the triceps may be palpated. The head of the radius may 
be detected as a globular swelling behind the external con- 
dyle. The lower end of the humerus forms a broad promi- 
nence in front of the articulation. This dislocation is dis- 
tinguished from a supracondyloid fracture by the following 
points : the olecranon is behind a line connecting the two 
condyles, the condyles do not move with the displaced ole- 
cranon, the distance between the acromion and the external 
condyle remains unaltered, and crepitus is absent. 

Reduction: The patient is 'seated in a chair, the surgeon 
places his foot upon the chair with his knee in the bend of 
the elbow, and presses against the lower end of the humerus, 
at the same time fixing the bones of the forearm by grasping 
them just above the wrist. "When this pressure has been 
maintained for some time, the forearm is slowly and forcibly 
flexed upon the arm. By this procedure the interlocking bony 
prominences are disengaged and reduction is effected. 

What are the principal causes of tinnitus aurium? 

Acute otitis media, chronic catarrhal otitis media, chronic 
suppurative otitis media, neurosis of the auditory nerve, 
Meniere's disease, impacted cerumen, anemia, alterations in 
pressure in the labyrinth, obstruction of the Eustachian tube, 
and large doses of quinine or of the salicylates. 

What are the most approved operative procedures in the 
treatment of varicose veins of the lower extremity? 

Excision of the entire vein, excision of a number of sections 
of the vein, excision of a portion of the internal saphenous 
vein (in certain cases), and complete division and double 
ligation of all the superficial veins at the junction of the 
upper and middle thirds of the legs (Schede's operation). 

Give the symptoms and treatment of section of the 
median nerve. 

If divided just above the wrist there will be anesthesia over 



SURGERY. 291 

the radial side of the palm, over the palmar aspect of the 
thumb, index, middle, and half of the ring fingers, and over 
the dorsal aspect of the terminal phalanges of the same 
fingers. There will be paralysis of the outer group of the 
short muscles of the thumb (abductor, opponens, and outer 
half of flexor brevis pollicis), as a result of which "opposi- 
tion" is impaired, the thumb remainng extended by the side 
of the fingers. The outer lumbricals are also paralyzed, caus- 
ing loss of power of flexion of the index and middle fingers 
at the metacarpo-phalangeal articulation. If divided at the 
bend of the elbow or in the arm, in addition to the previously 
mentioned symptoms, there will be loss of pronation (paralysis 
of flexor carpi radialis) , loss of power in the hand-grasp, par- 
ticularly on the radial side, with probable hyperextension of 
the wrist (paralysis of flexor longus pollicis, of the flexor 
sublimis, and of the outer half of the flexor profundus 
digitorum), and paralysis of the palmaris longus. 

Treatment: After all aseptic precautions have been carried 
out, the ends of the nerve are to be sought in the wound and 
approximated by sutures of the finest chromicized cat-gut. 
One or more sutures should pass through the nerve and the 
remainder merely through the sheath. A fine Hagedorn 
needle or a domestic sewing-needle without cutting edges 
should be employed. If difficulty is encountered in bringing 
the ends together, the wrist and elbow joints are flexed to a 
right angle, and subsequently maintained in this position by 
a fixed dressing. 

State the constitutional effects and give the treatment 
of burns. 

Stage of shock or collapse : The surface of the body is cov- 
ered with a cold and clammy SAveat, the temperature is sub- 
normal, the pulse is rapid and feeble, and the respirations 
are quick and shallow. The tongue is dry, the patient ex- 
periences great thirst, vomiting often occurs, and the urine 
and feces may be passed involuntarily. There is congestion 
of the internal viscera, particularly those in relation with 
the portal system. 



292 SURGERY. 

Stage of reaction: Symptoms of septic traumatic fever, 
with special symptoms dependent upon inflammatory affec- 
tions of the internal organs (meningitis, peritonitis, enteritis, 
duodenal ulcer) . 

Stage of exhaustion or recovery: Symptoms of septicemia 
or pyemia may make their appearance. Death may occur 
from inflammation of the lungs or pleura or from amyloid 
degeneration of the viscera. If repair is healthy, no abnormal 
constitutional condition follows the second stage excepting 
a certain amount of asthenia. 

Local treatment : Superficial burns without vesication sim- 
ply require a dusting powder such as flour or boric acid. 
If vesication is present, the blisters should be opened aseptic- 
ally, and the part enveloped in lint soaked in carron oil 
(equal parts of linseed oil and lime water, with one part of 
oil of eucalyptus in ten of the mixture), or in aqueous solu- 
tions of picric acid (1-200). In deep burns the part should 
be cleansed as thoroughly as possible, and covered by a 
moist antiseptic dressing until the sloughs separate, when the 
resulting granulating surface may be treated on general prin- 
ciples. During the process of cicatrization, great care must 
be exercised lest deformity result from contraction. Such 
deformity may be prevented by the use of splints or weights, 
and particularly by the employment of Thiersch's method of 
skin-grafting. When a limb has been hopelessly charred it is 
best to amputate in healthy tissue at the earliest favorable 
opportunity. 

Constitutional treatment: Promote reaction by external 
heat, hypodermatic injection of strychnine, and some warm, 
stimulating fluid given by the mouth or rectum. Intravenous 
injection of warm saline solution is advisable in some cases. 
If the pain is severe, opium may be administered. During 
the second stage the secretions should be kept active, and 
the patient placed on a liquid nutritious diet. In the third 
stage, tonics, stimulants, and nutritious easily-digested food 
are indicated. 



SURGERY. 293 

Name five of the principal complications of gonorrheal 
urethritis in the male. 

Lymphangitis, bubo, prostatitis, cystitis, and epididymitis. 

What are the indications for exsection of the knee= 
joint? 

Tubercular disease, disorganization of joint after pyemia 
or osteo-arthritis, old, neglected cases of infantile paralysis 
where there is a flail-like limb (Wright), certain cases of 
compound fracture (particularly after gunshot wounds), and 
deformity due to fibrous or bony ankylosis in a bad position. 

What is the treatment of depressed fracture of the 
skull? 

All such cases should be trephined under aseptic pre- 
cautions, and the exact amount of intracranial mischief deter- 
mined. The depressed fragment may then be elevated, and 
any pressure upon the brain immediately relieved. 

Give the indications for the removal of the mammary 
gland. 

Carcinoma, sarcoma, diffuse hypertrophy, diffuse septic or 
tubercular disease, and certain cases of interstitial mastitis. 

What is Paget's disease of the nipple? State the spe= 
cial significance of its occurrence. 

Paget's disease of the nipple is said by some to be a form 
of eczema, but, according to high authority, it is a destructive 
dermatitis of the papillary layer of the skin. It may be due 
to psorosperms, but this is not definitely settled. The nipple 
affected has an exccoriated, bright red surface, which dis- 
charges a yellowish viscid fluid. The excoriation spreads 
until the entire areola is involved and the patient complains 
of burning pain. 

The special significance of the occurrence of the disease is 
that it is almost always a precursor of cancer, but this is not 
invariably the case. 



294 SURGERY. 

What are the indications for incising the membrana 
tympani? 

The evacuation of serum, mucus or pus from the tympanum, 
the relief of anomalies of tension of the drum membrane, 
and to gain access to the tympanum for the purpose of re- 
moving intratympanic polypi or dividing synechia?. 

Describe the steps in the treatment of a scalp wound. 

Hemorrhage is to be controlled by pressure or ligation. The 
scalp should be shaved for a distance of several inches from 
the margins of the wound. If the wound is very extensive 
the entire scalp should be shaved. All foreign substances are 
removed from the wound, and it is disinfected with antiseptic 
solutions (bichloride 1-1000). The wound should now be 
sutured with silkworm gut and a moist bichloride dressing 
(1-4000) applied. If the wound subsequently shows signs of 
infection, one or more of the sutures should be immediately 
removed, the wound again disinfected, packed with iodoform 
gauze, and allowed to granulate. After granulation has oc- 
curred it may be closed by secondary sutures. Primary suture 
should be the routine treatment in almost every case. 

How can the danger of ankylosis be averted after injury 
to a joint? 

By surgical cleanliness, rest, and the early employment of 
massage and passive motion. 

What are the symptoms of morbus coxae in its different 

stages? 

First stage : Pain in affected joint and corresponding knee, 
limping or shuffling gait, more or less fixation of the joint 
from muscular rigidity, the knee is slightly flexed and the 
limb is usually abducted. Swelling is most marked in the 
arthritic variety of the disease. Heat and redness are usually 
absent on account of the distance of the articulation from 
the surface. 

Second stage : Pain is more acute, the child limps decidedly, 
atrophy of the thigh is apparent, and rigidity of the abductors 



SURGERY. 295 

is marked. The limb is somewhat flexed, abducted, everted, 
and apparently lengthened. Flattening of the buttocks is 
present, and the sulcus between the nates is no longer vertical, 
but inclined toward the affected side. Full extension and 
abduction are restricted, "starting" pains are present. 

Third stage : Flexion is marked, adduction is present, and 
shortening is observed which is apparent at first, but sub- 
sequently actual. The whole extremity, including the gluteal 
region, is greatly atrophied. If the diseased leg is extended 
so that the knee touches the table, the lumbar curve becomes 
so pronounced that there is frequently room for the arm of 
the surgeon between it and the table. The rima natium is 
inclined away from the affected side, and there is a compen- 
satory double lateral curvature of the spine. Abscesses may 
form and point at the outer side of the thigh below the tro- 
chanter (disease of head of femur), in the pubic region 
(disease of acetabulum), or in the gluteal region (either 
form). If the abscess points above Poupart's ligament, it is 
intrapelvic, if below, extrapelvic. 

What is hydrophobia and how is it treated? 

Hydrophobia is an acute infectious disease resulting from 
the inoculation of a specific virus from an animal suffering 
from rabies. 

Prophylactic treatment: Most important, as no curative 
treatment exists. The wound, if made by a supposedly rabid 
animal, should be freely excised or thoroughly cauterized 
(actual cautery is best, caustic potash, fuming nitric acid). 
If this cannot be done at once, constriction should be applied 
upon the proximal side of the wound. The wound resulting 
from excision should be thoroughly disinfected and sutured 
or treated openly, according to the exigencies of the case. 
Prophylactic inoculations with emulsions of the dried spinal 
cords of rabbits infected with hydrophobia (Pasteur treat- 
ment) should be made in all cases where the animal inflicting 
the bite was rabid, and in those cases in which it can not be 
proven that the animal did not have rabies. The prophy- 



296 SURGERY. 

lactic treatment also includes the muzzling of dogs and the 
rigid maintenance of a dog quarantine. 

Palliative treatment: The free use of morphine, chloral 
and chloroform. The patient is kept in a darkened room, 
and all external sources of irritation are removed. Nutritive 
enemata may be given. 

How would you perform tracheotomy? 

The patient is placed in the dorsal position, with the head 
extended, and a cylindric cushion placed beneath the neck. 
An assistant holds the head so that the median line of the 
face will correspond to the median line of the neck. After 
all aseptic precautions have been observed and the various 
landmarks (pomum Adami, cricoid cartilage) located, an 
incision, two and a half inches in length, is made in the median 
line, terminating at the lower border of the thyroid cartilage. 
This incision is made from below upward, and divides the 
skin and superficial fascia. The anterior jugular veins lying 
to either side of the median line should be avoided by cutting 
between them and drawing them aside. The deep cervical 
fascia is now divided, the interval between the pretracheal 
muscles recognized, and the wound deepened by blunt dissec- 
tion. The pretracheal fascia is now divided, and the isthmus 
of the thyroid gland drawn downward. After hemorrhage 
has been checked and the tracheal rings clearly exposed, the 
trachea is steadied by a tenaculum, and two or three rings 
are divided from below upward with a narrow-bladed knife. 
The edges of the tracheal wound are then held apart and the 
tracheal tube inserted. 

What are the symptoms of septic surgical fever? 

There is a sharp rise of temperature 24 or 36 hours after 
the operation or injury. The skin is hot and dry, the pulse 
is rapid, and the tongue is coated. Constipation, anorexia, 
local heat, thirst, restlessness and delirium are present. The 
urine is scanty and high colored. The lips of the wound are 
red, swollen and tender. The temperature falls with the 
advent of suppuration. 



SURGERY. 297 

What are the indications for trephining in fractures of 
the skull? 

All punctured fractures, all compound depressed fractures, 
all simple depressed fractures, and all cases in which there are 
symptoms of intracranial mischief. 

Mention the different kinds of displacement in fracture. 
In what directions does the line of fracture extend in the 
case of the long bones? 

Varieties of displacement: Angular, transverse, longitud- 
inal and rotary. 

Directions of line of fracture: Transverse, oblique, spiral, 
longitudinal, toothed, V-shaped, and T-shaped. 

What general principles govern the diagnosis of a tumor? 

The age and sex of the patient, hereditary influence, the 
history of previous trauma, the location, shape, size, con- 
sistency, and rapidity of growth of the tumor, whether the 
tumor is freely movable or fixed to the surrounding tissues, 
whether it is painful, whether it is encapsulated, whether it 
has given rise to metastases, and whether these have occurred 
through the lymphatics or through the blood-vessels, whether 
the neighboring lymphatic glands are involved, and the pres- 
ence or absence of cachexia. 

What is the most common seat of rupture of the quad= 
riceps extensor femoris? Give the symptoms and treat= 
ment. 

At its insertion into the patella. 

Symptoms: Sudden pain in the part, inability to extend 
the leg, and the appearance of ecchymosis several days after 
the injury. A swelling may be felt just above the patella 
(extravasation) or a gap may be observed (retraction of 
muscle). 

Treatment: The treatment usually advised is to place the 
part at rest, the leg being extended on the thigh, and the thigh 
being flexed at the hip. This position tends to bring the 



298 SURGERY. 

torn ends together. A certain amount of compression is made 
at the site of the injury, and the extremity is kept in the 
position described until union has occurred. If perfect 
asepsis can be obtained, however, primary suture of the mus- 
cle (if healthy) will give better results. 

What are the steps in the ligation of arteries? 

The preparation of the region in which the vessel is situated 
for an aseptic operation, the incision dividing the skin and 
superficial fascia (at an angle of about five degrees to the 
course of the artery), the division of the deep fascia, the 
recognition of muscular or bony landmarks, and the location 
of the vessel by its pulsations, the opening of the sheath, the 
passage of the aneurysm needle, the tying of the ligature, and 
the closure of the wound. 

Give the treatment for talipes calcaneus. 

Division of the extensor tendons. If the tendo Achillis is 
attenuated, a portion of it may be excised and the ends united 
by suture. In other cases the tendon of a healthy peroneus 
longus may be grafted into the tendo Achillis, or the tubercle 
of the os calcis, into which the tendo Achillis is inserted, may 
be sawn off and reattached by a peg to the bone at a lower 
level (Walsham). In the paralytic variety some form of 
apparatus must always be worn. 

What are the causes and treatment of paraphimosis? 

Causes : Gonorrheal balano-posthitis, ulceration from chan- 
cre or chancroid, violent coitus, and edema following upon 
the retraction of a tight prepuce. 

Treatment: The glans should be rendered bloodless by 
digital pressure or by the compression of a finger bandage 
and well anointed with sweet oil. The index and middle 
fingers of each hand are now crossed behind the glans and an 
attempt made to force the glans through the constricted pre- 
putial orifice by pressing upon it with the thumbs. If the 
edema of the prepuce is very marked, it may be punctured in 



SURGERY. 299 

several places to relieve tension. Should this measure fail, 
the preputial orifice (at the bottom of the second groove) is 
to be divided with a sharp-pointed, curved bistoury. Lead 
water and laudanum may then be applied to reduce the in- 
flammatory swelling. 

In what portion of the base of the skull may fractures 
lead to the escape of cerebro=spinal fluid? 

Cerebro-spinal fluid may escape through the nose in a frac- 
ture of the anterior fossa involving the cribriform plate of 
the ethmoid (if there is a laceration of the mucous membrane 
below the fracture and of the dura and arachnoid above it) ; 
it may escape through the ear in a fracture of the middle 
fossa (if the fracture passes across the internal auditory 
meatus, if the tubular prolongations of the membranes in this 
meatus are torn, if there is a communication between the 
internal ear and the tympanum, and if the membrana tym- 
pani is lacerated). 

Give the symptoms of sacroiliac disease and mention 
the affections from which it must be differentiated. 

Pain and a sensation of weakness in the lower part of the 
back, which is increased by standing, sneezing, or any move- 
ment which suddenly calls the abdominal muscles into play 
and drags on the ilium. The unfortunate individual feels 
as though his pelvis were coming to pieces. The pain is fre- 
quently referred to the gluteal region or leg (lumbo-sacral 
cord) . If the pelvis is not supported, movements of the lower 
extremity are painful. There is apparent lengthening upon 
the affected side, owing to the tilting downwards and forwards 
of the innominate bone. Lateral compression of the pelvis 
causes pain. The region over the joint is often swollen and 
tender. Abscesses may form, and these may point over the 
articulation, upwards into the lumbar region, forwards into 
the groin, or downwards into the pelvis. Sacro-iliac disease 
must be differentiated from sciatica, hip- joint disease, and 
lumbar spondylitis. 



300 SURGERY. 

Give the differential diagnosis between fracture of the 
neck of the humerus and dislocation of the shoulder joint. 

Fracture. Dislocation. 

Elbow readily approximated to side. Elbow cannot be approximated to 

side without causing great pain. 

Elbow can be made to touch chest Elbow cannot be made to touch chest 
with hand of affected extremity with hand of affected extremity 

upon the sound shoulder. upon the sound shoulder. 

Crepitus. No crepitus. 

Preternatural mobility. More or less fixation. 

Shape of shoulder joint unchanged. Flattening of shoulder joint, the head 

of the bone being felt in an ab- 
normal position. 

Deformity recurs after reduction. Deformity does not recur after reduc- 

tion. 

Shortening of the arm. Elongation may be present (sub- 

glenoid), or - the arm may be of 
same length as that of opposite 
side. 

What are the indications for thyroidectomy? 

Fibro-adenomatous and cystic goitres, parenchymatous 
goitres which increase in size in spite of palliative treatment, 
and carcinoma and sarcoma of the thyroid gland. 

Describe active congestion, passive congestion. State 
their points of difference. 

Active congestion is an increase in the amount of blood in 
the more or less dilated arteries of a part, with an increase in 
the velocity of the blood stream. 

Passive congestion is an increase in the amount of blood in 
the more or less dilated veins and capillaries of a part, with a 
diminished velocity of the blood stream. 

In active congestion the part is reddened, not perceptibly 
enlarged, and the velocity of the blood current, the tempera- 
ture and the functional activity of the part are increased. 

In passive congestion the part is bluish, greatly swollen, 
and the velocity of the blood current, the temperature and 
the functional activity of the part are diminished. 



SURGERY. 301 

What is the usual site of a vulvovaginal abscess? Give 
the symptoms and treatment. 

In the glands of Bartholin at either side of the entrance of 
the vagina. 

Symptoms: Heat, redness, and tenderness, together with a 
peculiar pyriform swelling. In the early stages this swelling 
is best detected by introducing the finger in the vagina and 
pressing outward against the pubic ramus. 

Treatment: Incision and drainage. The wound should be 
irrigated, packed with iodoform gauze, and made to heal up 
from the bottom. The principles of antisepsis obtain here as 
elsewhere. 

How would you operate for the radical cure of complete 
fistula in ano? 

The bowels should be completely evacuated by a suitable 
purgative, and also by an enema, about an hour before the 
operation. The patient is etherized, placed in the lithotomy 
positon, and the perineal and anal regions shaved and prop- 
erly cleansed. The external sphincter is forcibly stretched 
by the thumbs in the rectum, and a grooved director is then 
passed into the external orifice of the fistula, through the 
fistulous tract, and brought out through the internal orifice. 
A curved bistoury is now introduced along the grooved 
director, and all the overlying tissues are divided. Ail 
pockets and tributary branches of the fistula must be opened 
up and curetted. All undermined tissue and unhealthy tags 
of skin should be removed. Hemorrhage should be checked, 
the cavity carefully packed with iodoform gauze, and com- 
pression made over the anal region by a thick pad of sterile 
gauze and a T-binder. 

What affections occur on the female external genitalia? 

Vulvitis, vulvovaginal abscess, vulvovaginal cyst, hema- 
toma of vulva, pruritus vulvae, hypertrophy of the clitoris or 
of the nymphae, urethral caruncle, noma pudendi, chancre, 
chancroid, syphilitic ulcerations, venereal warts, papilloma, 



302 SURGERY. 

myxoma, and epithelioma. A labial hernia or a hydrocele of 
the round ligament may make its appearance in this situ- 
ation. 

What is the cause of the impulse felt in a scrotal hernia 
on coughing? When is this impulse absent in such a her= 
nia, and in what other condition resembling hernia may it 
be present? 

In a scrotal hernia a portion of the abdominal cavity is, so 
to speak, within the scrotum, and any increase in the intra- 
abdominal pressure will, of course, be transmitted to the 
hernial sac. 

This impulse is absent when strangulation is present. 

An impulse on coughing may be present in a congenital 
hydrocele. 

Differentiate between true and false sacculated aneu= 
rysm. 

The sac of a true sacculated aneurysm contains all of the 
coats of the blood-vessel. In a false sacculated aneurysm 
some of the coats of the blood-vessel are absent. 

Describe the signs of each variety of fistula in ano. 

Complete fistula: There is an external opening in the skin 
and an internal opening in the bowel. 

Incomplete external fistula: There is an external opening, 
but no internal opening. 

Incomplete internal fistula: There is an internal opening, 
but no external opening. The internal opening may be dis- 
covered by direct inspection through a speculum and some- 
times by palpation. This fistula is often associated with 
undermining of the mucous membrane or with stenosis of the 
bowel. Signs of inflammation may be present and pus may 
be discharged from the rectum. 

Describe the several varieties of clubfoot. 

Talipes equinus. The heel is drawn up and the patient 
walks upon his toes. 



SURGERY. 303 

Talipes calcaneus. The toes are raised from the ground 
and the patient walks upon his heel. 

Talipes varus. The anterior half of the foot is adducted, 
the inner side of the foot is raised, and the patient walks upon 
the outer side. 

Talipes valgus. The anterior half of the foot is abducted 
and everted, the patient resting upon the inner side of the 
foot. Various combinations of these forms are indicated as 
follows : Talipes equino-varus, talipes equino-valgus, talipes 
calcaneo-varus, and talipes calcaneo- valgus. 

Name the most common varieties of fistula. 

Fistula in ano (complete, blind internal, blind external), 
vesico-vaginal, urethro-vaginal, recto-vaginal, urinary, sali- 
vary, biliary, and intestinal. 

What is lupus? 

Lupus vulgaris is a chronic inflammatory disease of the 
skin and mucous membranes due to the tubercle bacillus, and 
characterized by the formation of nodules of granulation tis- 
sue. These nodules usually ulcerate (lupus exedens), but 
such is not always the case (lupus non-exedens). 

What are the indications for enucleation of the globe? 

Malignant disease, either primary or extending from adja- 
cent tissues, rupture and collapse of eye-ball, a large irregular 
foreign body in the eye not capable of being successfully 
removed, a large wound in the dangerous region in which 
little hope of obtaining useful sight remains, a small wound 
in the dangerous region with commencing irido-cyclitis, a small 
foreign body not removable by the electro-magnet and causing 
inflammation and shrinking, a wound in the dangerous region 
complicated with traumatic cataract, a corneal wound in 
which severe iritis and panophthalmitis develop in spite of 
treatment, and any case in which sympathetic ophthalmia is 
threatened. (Modified from Jacobson.) 

Give the symptoms, diagnosis, and treatment of phle= 
bitis. 

Symptoms : The vessel affected becomes swollen, hard, and 



304 SURGERY. 

painful. Localized enlargements corresponding to the posi- 
tion of the valves are observed. The overlying tissues are 
dusky and congested, and there may be some edema in the 
area drained by the vein. The part is hot to the touch and 
the patient usually has fever. If suppuration occurs the 
symptoms are those of a localized abscess. 

Diagnosis: In lymphangitis the redness is brighter and 
more localized, enlarged and painful glands are present, there 
is no hard cord-like vein, and the swelling is much less marked. 
In erysipelas the redness is characterized by an abrupt raised 
margin, and gastric disturbances are frequently present. 

Treatment: Absolute rest in bed, with e^vation of the 
affected extremity to promote the return of venous blood. 
The affected area is covered with a mixture of equal parts of 
extract of belladonna and glycerine, and the limb is swathed 
in a thick layer of cotton and lightly bandaged to a splint. 
The diet should be nutritious and non-stimalating. When 
the inflammatory symptoms have subsided, and the clot has 
had time to become organized or absorbed, massage should be 
practiced to get rid of the edema and inflammatory thicken- 
ing. If an abscess forms it should be opened antiseptically. 

In septic phlebitis, if seen early, the vein should be ex- 
posed, ligated, the whole of the infective clot turned out, the 
vessel swabbed out with pure carbolic acid or bichloride solu- 
tion (1-500), and stuffed with antiseptic gauze. If the 
deeper veins are infected a,nd this treatment is impossible, 
amputation may be demanded, provided that general infec- 
tion has not taken place. 

Give the causes, symptoms, and treatment of acute 
vaginitis. 

Causes: The presence of irritating foreign bodies, the use 
of irritating injections, the contact of irritating secretions, 
the irritation of excessive coition, and infection with gonor- 
rhea. 

Symptoms : Local heat, pain, and muco-purulent discharge. 
Inspection shows congestion and sometimes excoriations of 
the vaginal mucous membrane. 



SURGERY. 305 

Treatment : Rest in bed, saline cathartics, and frequent hot 
hip-baths. The vagina should be copiously douched twice 
daily with borax (one dram to a quart of water) or with 
liquor plumbi subacetatis (half a fluid-ounce to a quart of 
water). As soon as the acute symptoms have subsided the 
walls of the vagina should be separated by a fold of lint 
soaked in oxide of zinc cream. This lint should be carried 
well up into the posterior fornix, allowed to protrude at the 
vulva, and changed every 24 hours. After the disease has 
subsided the parts should still be douched occasionally to 
prevent recurrence. 

In gonorrheal vaginitis the vagina should be washed out 
every two or three hours, first with a pint or two of an alka- 
line solution, then with a pint of plain water, and then with 
a pint of a medicated solution (acetate of lead, acetate of 
zinc, sulphate of zinc, protargol, alum, tannin) . 

Define homologous tumor, heterologous tumor. 

A homologous tumor is a tumor consisting of tissue iden- 
tical with that of the part in which it grows. 

A heterologous tumor is a tumor consisting of a different 
tissue from that of the part in which it grows. (These tumors 
are more properly called heterotopic tumors.) 

How are dislocations distinguished from fractures? 

Dislocations are characterized by more or less immobility, 
by the absence of crepitus, and by the fact that the deformity 
does not usually recur after reduction. 

Fractures are characterized by preternatural mobility, by 
the presence of crepitus, and by the fact that the deformity 
usually recurs after reduction. 

What is milium? Give the treatment. 

Milium is an affection characterized by the appearance of 
small, pearly, non-inflammatory elevations, which result from 
the accumulation of inspissated sebum in ducts, the outlets of 
which have been occluded. 
20 



306 SURGERY. 

Treatment: The lesion should be excised, the contents ex- 
pressed, and the same remedies employed as in seborrhea 
(improvement of general health, relief of constipation, and 
the application of ointments of sulphur, mercury, tar, car- 
bolic acid, or resorcin) . 

Describe an operation for circumcision. 

After all aseptic precautions have been carried out, the 
prepuce is drawn forward and grasped by a clamp placed 
just in front of the glans. The portion of the prepuce in 
front of the clamp is then cut off with a sharp bistoury and 
the clamp removed. It will be observed that the skin has been 
removed, but that the mucous surface of the prepuce still 
covers the glans. One blade of a pair of scissors is now intro- 
duced into the preputial orifice and the mucous layer divided 
down to its attachment to the corona. All adhesions between 
the prepuce and glans must be thoroughly broken up and the 
smegma removed. The entire mucous surface of the pre- 
puce is to be trimmed away to within an eighth of an inch of 
its attachment to the corona. Special attention should be 
given to the removal of sufficient tissue from the under side 
of the penis in order to avoid an unsightly projection in the 
neighborhood of the frenum. Hemorrhage should now be 
controlled, the edges of the wound adjusted by a few fine 
catgut sutures, and the line of incision covered by some non- 
irritating antiseptic dressing. 

Give the local treatment of venereal bubo. 

Syphilitic bubo requires no local treatment. 

Gonorrheal bubo may sometimes be aborted by the use of 
pressure and iodine. If the gland suppurates it should be 
incised under antiseptic precautions, curetted, and treated 
like any abscess. If the suppuration is within the gland and 
limited by the capsule the entire mass should be dissected out 
and the wound closed by primary suture. The latter treat- 
ment is the best method of dealing with suppurating buboes, 
provided that it is adopted at the proper time. 



SURGERY. 307 

Give the palliative and the remedial treatment of hydro= 
cele. 

Palliative treatment: Tapping, the use of the suspensory, 
and evaporating lotions (when inflammation of the testicle 
is present) . 

Remedial treatment : Tapping and injection should never 
be employed. The open method of treatment is now gener- 
ally adopted. One of two methods may be pursued: 1. The 
cavity of the tunica vaginalis may be opened and the tunica 
stitched to the skin. The cavity is drained, washed out daily, 
and the drainage tube gradually shortened. Instead of a 
tube, the cavity may be packed with iodoform gauze. 2. 
The parietal layer of the tunica vaginalis may be excised. 

Give the differential diagnosis of congenital talipes 
equino=varus and paralytic talipes equino=varus. 

In congenital talipes equino-varus the affection exists from 
birth, it is usually bilateral, the circulation is good, there is 
but little wasting of the muscles, the electric reactions are not 
much impaired, the groAvth of bone is much as usual, and 
furrows are present in the sole. 

In paralytic talipes equino-varus the affection is not de- 
veloped until the second or third year (ushered in by convul- 
sions and fever), it is more frequently unilateral, the circula- 
tion is feeble, the muscles show extreme wasting, electrical 
reactions are almost entirely absent in the paralyzed muscles, 
the growth of the bones is considerably diminished, and there 
are no furrows in the sole (after Tubby). 

Describe an approved method for the removal of im= 
pacted cerumen. 

The external auditory meatus is to be syringed with warm 
water (105° F.), to which some bicarbonate of soda has been 
added, and the syringing continued until the canal has been 
thoroughly cleansed. The soda solution is then to be washed 
out with sterile water, the ear wiped dry, and a cotton plug 
worn until bedtime. If the mass should prove obdurate, a 
little warm sweet oil may be dropped into the meatus several 



308 SURGERY. 

times during the succeeding 24 hours, and the attempt re- 
newed upon the following day. 

Define malignant pustule and give treatment. 

Malignant pustule or anthrax carbuncle is a local lesion 
produced by infection with the bacillus anthracis. It differs 
from ordinary carbuncle in the following respects: Presence 
of a central depressed blackish slough, absence of localized 
pain, absence of suppuration (unless mixed infection is pres- 
ent), and the constitutional symptoms are more marked. 

Treatment: Complete excision at the earliest possible mo- 
ment. The incisions should be carried wide of the disease, 
and. the resulting wound should be carefully swabbed over 
with pure carbolic acid or with a solution of zinc chloride 
(1:8). The constitutional treatment should be of a support- 
ing character. 

What are the parietal effects of a severe blow upon the 
abdomen? 

Swelling, discoloration, tenderness, and pain. If a vessel 
of considerable size is lacerated a large extravasation of blood 
will take place, which may descend into the scrotum. Rup- 
ture of one of the muscles of the abdominal wall may occur, 
and this is most frequently observed in the rectus. As far 
as the abdominal parietes are concerned, contusions may re- 
sult in localized peritonitis, abscess, or in ventral hernia. 

Describe the symptoms of fracture of the base of the 
skull in the middle fossa. 

Hemorrhage from the external auditory meatus, or from 
the nose. The blood may be swallowed and subsequently 
vomited. Cerebro-spinal fluid may be discharged from the- 
external auditory meatus, and, when present, is one of the 
most characteristic signs of fracture in this situation. If 
the facial and auditory nerves are injured as they lie in the 
external auditory meatus, there will be signs of paralysis of 
the muscles of expression and deafness upon the affected side. 
In addition to these local signs, symptoms of concussion, of 
compression, or of laceration of the brain may be present. 



SURGERY. 309 

What genera! methods obtain in plastic operations? 

Displacement : Stretching or sliding of tissues. 1. Simple 
approximation after freshening the edges; 2. Sliding into 
position after the transference of tension to adjoining 
localities. 

Interpolation: The tissue is taken from adjacent regions, 
from a limb, or from another person. 1. Transferring a flap 
with a pedicle; 2. Transplanting without a pedicle (includ- 
ing skin-grafting) . 

Retrenchment: The removal of redundant material causing 
cicatricial contraction. (Abbreviated from Keen and White.) 

What is the treatment of diphtheritic stenosis of the 
larynx? 

Intubation or tracheotomy. The usual treatment of diph- 
theria should also be instituted or continued (injection of 
diphtheria antitoxin, administration of whiskey, hypoder- 
matic injections of strychnine, absolute rest in bed, nutritious 
fluid diet). If tracheotomy has been performed the temper- 
ature of the room should be maintained at 80° F., and the 
air kept moist with steam. 

Describe a compound fracture. 

A compound fracture is one in which the seat of fracture 
communicates with the external air. Such a fracture may 
be compound through the skin or through the mucous mem- 
brane. These fractures are also called open fractures. 

Give the etiology, varieties, and symptoms of erysipelas. 

Etiology : Infection with the streptococcus erysipelatis. 

Varieties: Cutaneous, cellulo-cutaneous (phlegmonous), 
and cellular (cellulitis). 

Symptoms: Cutaneous erysipelas is usually ushered in by 
a chill and more or less gastric disturbance. Within 24 hours 
a rash appears in the neighborhood of the wound. There is 
increased tension in the part and a sensation of itching. The 
rash is yellowish-red in color, disappearing upon pressure, 
and has a characteristic elevated border. The area affected 



SHU SURGERY. 

is well defined, and the margins usually present an irregular 
zigzag outline. When the inflammation reaches its height 
the glazed area is covered with vesicles or bullas filled with a 
clear fluid, which soon becomes turbid. The rash advances 
more or less rapidly with a continuous margin (remaining 
in one situation for about four days), and as it extends to 
new areas it fades in the region first involved and undergoes 
branny desquamation. The neighboring lymphatic glands 
are usually enlarged and painful, Fever is present as long 
as the rash persists. In severe cases the fever is at first 
sthenic, the pulse full, and the delirium noisy and active, but 
the pulse subsequently becomes quick and weak, and there is 
low muttering delirium and great prostration. 

What is shock, and how should it be treated? 

Shock is the immediate constitutional effect of an injury. 

Treatment: In mild cases very little is needed except rest 
in the recumbent position and the exhibition of some pungent 
aromatic to the nostrils. In more severe cases the patient 
must be put absolutely at rest, surrounded by blankets and 
hot water bottles, and all external sources of irritation re- 
moved. Over-stimulation should be avoided, and in many 
cases a cup of hot beef tea may do as much good as a stronger 
stimulant. If the patient appears to be in imminent danger, 
however, more active measures must be adopted. The head 
should be kept low and surrounded with flannel cloths wrung 
out of hot water and frequently renewed. The extremities 
should be wrapped in blankets and external heat applied, 
care being taken not to burn the patient. Ammonia should 
be exhibited to the nostrils and small quantities of brandy 
given by the mouth. If the patient cannot swallow, the 
brandy may be diluted and given by the rectum. The rectal 
injection of two or three pints of warm normal saline solution 
(100° F.) is highly recommended. Ether, digitalis, atropine, 
or strychnine may be given subcutaneously, the latter drugs 
being particularly valuable. If the shock is combined with 
loss of blood, a pint of sterile normal saline solution should 



SURGERY. 311 

be injected beneath the skin or into a vein. If a mangled 
limb seems to act as a source of depression it may be proper, 
under certain circumstances, to amputate at once. 

What are the symptoms and treatment of a sprain? 

Symptoms : The patient immediately experiences severe 
sickening pain. Swelling soon makes its appearance, due at 
first to extravasation of blood and subsequently to the effu- 
sion of inflammatory products. The patient is unable to bear 
any weight upon the injured extremity, and motions of the 
joint are attended by exacerbations of the pain. 

Treatment : Early and systematic massage is invaluable in 
these injuries. Ten or twenty minutes is usually enough for 
the first treatment, and the period can be lengthened upon 
the following days. During the intervals between the mas- 
sage of the part, it should be kept at rest upon a well-padded 
splint and moderate compression applied. The immediate 
application of cold, followed by heat, is of great advantage 
in some cases. If the sprain is in the ankle or wrist, the 
patient should be encouraged to move his toes or fingers Avhile 
the massage is being performed. The old treatment con- 
sisted in keeping the part at rest until all pain and swelling 
had disappeared, and then employing massage and passive 
motion. 

How and in what part of the inferior maxillary bone is 
fracture most liable to occur, and what is the treatment? 

The inferior maxillary bone is usually fractured by direct 
violence. 

The most frequent site of fracture is at a point just ante- 
rior to the mental foramen. 

Treatment: Reduction of the displacement, the application 
of a Barton bandage and the maintenance of the oral cavity 
in as aseptic condition as possible. In some cases a leather 
or pasteboard splint may be applied over the point of the 
chin. If there is a great displacement a Hammond splint 
may be placed about the teeth or, if these are defective, 
Kingsley's apparatus may be employed. Some few cases may 



312 SURGERY. 

require wiring of the fragments. The parts are to be kept 
at rest for about three weeks, the patient being restricted to 
a fluid diet. 

What are the various methods of administering ether? 

Ether may be administered by the open or by the closed 
method, the former being practically universal in this coun- 
try. The administration of ether may be preceded by the 
inhalation of nitrous oxide or chloroform (mixed anesthesia). 
Ether is also administered in the form of the A. C. E. mix- 
ture, but this is not to be recommended. 

Describe enucleation of the eye=foa!L 

Bonnet's method: All aseptic precautions having been car- 
ried out, the conjunctiva near the cornea is grasped by for- 
ceps and divided with scissors entirely around and close to 
the corneal margin. The conjunctiva is loosened up from 
the eye-ball and the dissection carried well back in every 
direction. The recti muscles are now caught up separately 
by a strabismus hook and their tendons divided close to the 
ball. After the orbital tissues have been well dissected aw T ay 
from the ball the enucleation scissors are passed back in the 
orbit until they touch the optic nerve, when their blades are 
opened and the nerve divided as far back as possible. The 
oblique muscles and other remaining tissues are now quickly 
severed, the hemorrhage is checked by hot water or torsion, 
and the orbit flooded with a hot bichloride solution (1:5000). 

A drainage tube is then inserted into the cavity and an 
antiseptic dressing applied. 

How is resection of the spinal accessory nerve effected? 
What are the reasons for this operation? 

After all aseptic precautions have been observed, an inci- 
sion is made along the anterior border of the sterno-mastoid 
muscle, extending from the mastoid process to the cornu of 
the hyoid bone and avoiding the external jugular vein. This 
incision divides skin, superficial fascia, platysma, a branch 
of the auricularis magnus, and the deep fascia. The sterno- 



SURGERY. 313 

mastoid is now drawn outward, and the nerve (with its accom- 
panying sterno-mastoid artery) can be felt just below the 
transverse process of the atlas. The nerve emerges from 
beneath the posterior belly of the digastric and lies upon the 
levator anguli scapulas, beneath the prevertebral fascia. It 
enters the deep surface of the sterno-mastoid muscle midway 
between its two borders and one inch below the tip of the 
mastoid process. A portion of the nerve is now excised, the 
external wound sutured, and an aseptic dressing applied. 
The spinal accessory nerve is excised for spasmodic torti- 
collis of central origin. 

What are the methods of reduction in sub=coracoid dis= 
location of the humerus? 

1. Reduction by manipulation (Kocher's, Smith's). 

2. Extension and counter-extension. 

3. Traction in an outward and upward direction. 

How would you arrest epistaxis? 

If position, rest, cold, hot water, pressure, and spraying 
with peroxide or with a 5 per cent, solution of antipyrine 
(with 2 per cent, cocaine) are inefficient, more active meas- 
ures must be adopted. If the bleeding point can be seen it 
should be cauterized (electricity, chromic acid). When other 
means fail the anterior nares should be packed with a strip 
of sterile gauze, the initial extremity of which is carried well 
back toward the naso-pharynx. In rare cases it may be 
necessary to plug the posterior nares by means of Bellocq's 
cannula or a soft rubber catheter. Plugs of gauze should 
never be left in the nose unchanged for more than 24 hours. 

Differentiate between the following forms of inflam- 
mation: Serous, sero=iibrinous, serohemorrhagic. 

In serous inflammation there is a copious exudation of fluid 
with comparatively little cellular matter. 

In sero-fibrinous inflammation the exudate contains more 
fibrin, and shows a marked tendency to clot. 

In sero-hemorrhagic inflammation the exudate contains 



314 SURGERY. 

large numbers of red blood corpuscles, and is correspondingly 
tinged. 

What is hare=Iip? Give the treatment of hare=lip. 

By hare-lip is meant a congenital fissure of the upper lip 
which may extend for a variable distance through the soft 
tissues. It may be associated with a cleft in the palate. 

Treatment : A straight bistoury should be introduced just, 
above the angle of the fissure, and both sides of the cleft pared 
by cutting through the lip in a crescentic manner so as to 
constitute a slight angular projection or prolabium when the 
freshened surfaces are brought into apposition. If the nose 
is much flattened more tissue should be removed from the 
outer than from the inner side, so that when the parts are 
sutured together the nostrils become as nearly symmetrical 
as possible. By paring the edges in a curved or angular 
manner the depth of the lip is increased to allow for subse- 
quent contraction. Two deep silk-worm-gut sutures should 
be introduced, one just above the red margin and one close 
to the nose. The vermilion borders must be accurately ap- 
proximated and the edges of the wound carefully brought 
together with cat-gut sutures. The dressing consists of gauze 
and collodion. The gauze is cut in the shape of a paddle, the 
broad ends being fastened to the cheek. This should be so 
applied as to prevent tension upon the wound. The silk- 
worm-gut sutures are removed upon the fourth day. The 
operation above described is that of Malgaigne. Other opera- 
tions are those of Nelaton, Rose, Mirault, and Konig. Double 
hare-lip may sometimes be treated by operating upon each 
side, as in a unilateral cleft, but if the os incisivum projects 
it must be either removed or replaced. 

Give the etiology of inflammation. 

Predisposing local causes: Defective circulation, loss or 
impairment of the nervous supply of a part, a previous attack 
of inflammation. 

Predisposing constitutional causes: Anything producing 
an impairment of the general health, such as old age, weak 



SURGERY. 315 

action of the heart, an unhealthy condition of the blood, and 
the presence of some constitutional disease. 

Exciting causes : Mechanical irritants, heat, cold, electric 
irritants, toxic irritants (chemical, vegetable, animal), and 
micro-organisms. 

Give the treatment of fracture of the ribs. 

The affected side should be firmly strapped with strips of 
adhesive plaster so as to limit its range of motion. These 
strips (2 inches in width) should extend beyond the median 
line both anteriorly and posteriorly, and are to be applied 
from below upward, each strip overlapping about one-half of 
its predecessor. Each strip should be put on while the chest 
is in a state of forcible expiration. If the patient has ad- 
vanced pulmonary emphysema or chronic bronchitis, strap- 
ping is not advisable, as it adds to the respiratory difficulty, 
and in such a case the patient must be placed in bed or 
propped up, and the fracture left to take care of itself. 
Strapping is also contra-indicated if the broken fragments 
are driven inwards, and if the fracture is in the lower part of 
the chest and the pressure irritates the diaphragm, causing 
hiccough. If there are associated injuries of the thoracic 
viscera, pneumo-thorax, or hemothorax, they must be appro- 
priately treated. 

Mention the varieties of hip=joint dislocation, and de= 
scribe in detail two of these varieties. 

Dorsal, dorsal below the tendon (sciatic), thyroid, and 
pubic. 

Dorsal dislocation : The head of the bone lies upon the dor- 
sum ilii, the trochanter is above Nelaton's line and nearer to 
the anterior superior spine, the ilio-tibial band is relaxed, and 
there is a shortening of two or three inches. A marked 
hollow is present in the upper part of Scarpa's triangle, and 
the head of the bone cannot be felt in its usual position. The 
thigh is flexed, adducted, and inverted, so that the axis of the 
femur crosses the lower third of the sound thigh and the ball 
of the toe rests upon the opposite instep. The ligamentum 



316 SURGERY. 

teres is torn and the capsule is lacerated. The small external 
rotator muscles are usually lacerated, as may also be the 
glutei and the pectineus. The great sciatic nerve may be 
contused or compressed. The ileo-femoral ligament is un- 
injured. 

Dorsal below the tendon (sciatic) : The signs of this dis- 
location are somewhat similar but less marked than in the 
preceding form. There is not so much shortening, since the 
intact obdurator internus tendon prevents the head of the 
bone from traveling upward. The shortening is not more 
than one-half inch or an inch, but it becomes more apparent 
upon flexing the thigh (Allis). The thigh is flexed, ad- 
ducted, and inverted, but the axis of the femur crosses the 
opposite knee and the great toe rests against the ball of the 
great toe of the sound side. The head of the bone is palpated 
with great difficulty owing to the greater thickness of the 
gluteal muscles at this level. Practically the same muscles 
and ligaments are injured as in the dorsal variety. The head 
of the bone is below the tendon of the obdurator internus, 
whereas in the former dislocation it is above it. 

Make a differential diagnosis of coma from injury, apo= 
plexy, uremia, opium poisoning, and alcoholic intoxication. 

Concussion : The individual is pale, the pulse is feeble and 
fluttering, the respirations are sighing, the skin is cold and 
clammy, and the urine and feces may be passed involuntarily. 
The pupils vary, sometimes being unequal, but they usually 
react to light. Convulsions occasionally occur. Paralysis is 
not present, and examination of the extremities may give 
some evidence that they have not lost their sense of feeling. 
The patient can usually be aroused by shouting. 

Compression: The unconsciousness is complete and the 
pupils are dilated and do not respond to light. The skin is 
usually hot and bathed in perspiration. The respirations are 
slow, stertorous, and have a peculiar puffing character, due 
to the paralysis of the muscles of the cheeks. The bladder 
and intestines are usually paralyzed, but the incontinence of 
retention may be present. The pulse is slow, full, and fre- 



SURGERY. 317 

quently irregular. The whole body may be paralyzed, but 
hemiplegia is the form most commouly observed. Mono- 
plegias also occur, and are extremely valuable from the 
standpoint of localization. 

Apoplexy: Absolute unconsciousness, stertor, hemiplegia 
or complete paralysis are present. Aid in the diagnosis is 
furnished by the age of the patient and the condition of the 
arteries. The temperature is usually higher in one axilla, 
and conjugate deviation may be observed. The face is 
flushed, the conjunctiva is injected, the pulse is full and slow, 
and the breathing is stertorous. Urine and feces may be 
passed involuntarily, and convulsive seizures are not infre- 
quent. 

Uremia: Paralysis and stertor are absent (unless apoplexy 
co-exists) . The legs may be edematous and the urine contains 
albumin and casts. The breath is urinous, arterial tension is 
high, and the aortic second sound is accentuated. 

Opium poisoning: Paralysis is not present, and the pupils 
are pin-point and will not dilate. The odor of laudanum 
may be detected upon the breath. The pulse and respira- 
tions are slow. 

Alcoholic intoxication: Unconsciousness is not complete 
and it is usually possible to arouse the patient. Some aid 
may be furnished by the appearance of the patient, but this 
is frequently misleading. Although the breath may be alco- 
holic, it must be remembered that alcohol may have been 
given in an attempt to revive the individual. The pupils are 
usually contracted but dilate when the patient is aroused. 
The temperature is generally subnormal. 

Give the symptoms and treatment of hammertoe. 

Symptoms : Hyper-extension of the first phalanx, flexion of 
the second to an acute angle, and either flexion or extension of 
the terminal phalanx. The first interphalangeal joint rubs 
against the upper leather of the shoe, and the patient walks 
upon the extremity of the terminal phalanx. Corns are pres- 
ent over the points of pressure, and there is a subcutaneous 
bursa over the head of the first phalanx, causing great pain 



318 SURGERY. 

and discomfort. The affection is most frequently, observed 
in the second toe. 

Treatment: If the case is seen early, treatment may be 
commenced with the wearing of correctly shaped boots, but 
the affection has usually progressed so far that the excision 
of the first inter phalangeal joint or amputation of the toe is 
required. The first operation is the preferable one, since 
amputation is frequently followed by hallux valgus. 

Describe dermoid cysts. In what situations are they 
most commonly found? 

Dermoid cysts are cysts composed of structures which 
naturally belong to the skin or mucous membranes, but which 
occcur in situations where these structures are not normally 
found. They may contain all the elements of the skin, such 
as stratified epidermis, a papillary layer, and even subcuta- 
neous connective tissue. Hair follicles and sebaceous glands 
are frequent, and hairs of varying length are almost always 
present. Some forms of dermoids contain teeth, nerve tissue, 
muscle, and bone, and structures resembling intestine are not 
of uncommon occurrence. They have been classified by 
Bland Sutton into sequestration dermoids, tubulo-dermoids, 
and ovarian dermoids. 

Dermoid cysts are found in the ovary, in the testicle, in the 
peritoneum, at the outer angle of the orbit, above the nose, in 
the neck, in the floor of the mouth, in the membranes of the 
brain, and elsewhere. 

Give the symptoms of shock, and state when the prog= 
nosis is grave. 

Symptoms : The skin is pale, cool, and bathed in perspira- 
tion, the pulse is rapid and weak, the respirations are shallow 
and irregular, and the temperature is subnormal. Nausea 
and vomiting may occur, and the feces and urine may be 
passed involuntarily. The symptoms vary according to the 
severity of the injury, and the patient may suffer from any- 
thing from a sensation of momentary weakness and faintness 
to a most profound muscular relaxation and unconsciousness. 

The prognosis is grave when a vital part is injured, when 



SURGERY. 319 

the injury is extensive, entailing a continued source of irrita- 
tion and depression, when a reaction as regards temperature 
is not observed within four hours after the reception of the 
injury, when large quantities of blood have been lost, and in 
old people who are the subjects of degenerative changes. 

How would you proceed surgically to remove the fluid 
in a case of ascites? 

The patient is seated in a chair and the abdomen is encir- 
cled with a flannel binder, the ends of which are split to 
within six inches of the median line. The untorn portion of 
the binder is placed over the front of the abdomen and the 
divided ends are crossed behind and held by assistants so as 
to make continuous pressure upon the abdominal contents. 
A spot is selected in the median line below the umbilicus 
where absolute dulness is obtained upon percussion. After 
all aseptic precautions have been observed, the skin over this 
small area is anesthetized by a drop of carbolic acid or by the 
intradermic injection of Schleich's solution, a small incision 
is made through the skin, and a suitable trochar and cannula 
is inserted. The fluid should be withdrawn sloAvly, continu- 
ous pressure being made upon the abdominal contents by 
means of the flannel binder. All of the fluid should not be 
withdrawn. After the withdrawal of the cannula the small 
wound should be closed with aseptic gauze and sterile col- 
lodion. 

Differentially diagnose impacted and non=impacted frac= 
ture of the neck of the femur. 

Impacted Fracture. Son-impacted Fracture. 

Crepitus is absent. Crepitus may be obtained. 

Eversion is less marked and inversion Eversion is present. 

maybe present (rare). 

The head of the femur moves under The head of the femur does not move 

the finger when the extremity is under the finger when the extrerm 

rotated. ity is rotated. 

The shortening is not overcome by Shortening is overcome by extension. 

moderate extension (danger!). 

The symptoms of fracture are not so The symptoms of fracture are more 

marked. marked. 

The individual may be able to walk The individual is unable to walk* 

(do not allow her to try). 



320 SURGERY. 

Name and describe the different varieties of fracture. 

Simple (subcutaneous) : No communication with external 
air. 

Compound (open) : Communication with external air. 

Complete : The entire thickness of the bone is involved. 

Incomplete : The entire thickness of the bone is not involved. 

Multiple : The bone is fractured in more than one place and 
the lines of fracture do not communicate. 

Single : The bone is fractured in but one place. 

Comminuted : The bone is fractured into a number of frag- 
ments and the lines of fracture communicate with each other. 

Complicated: In addition to the fracture, a neighboring 
joint is dislocated, the main artery or nerve of the extremity 
is injured, or there is a severe laceration of the soft parts. 

Fissured: A linear split without displacement. 

Stellate : The lines of fracture radiate from a central point. 

Depressed : There is a crushing in of a portion of the bone. 

Impacted : One fragment is driven into the other. 

Apophyseal: A separation of a scale of bone to which a 
ligament or tendon is attached. 

Longitudinal, transverse, oblique, and spiral: The designa- 
tions indicate the directions of the line of fracture. 

Name five antiseptic agents that are available in general 
surgery. 

Bichloride of mercury, carbolic acid, formaldehyde, boric 
acid, and salicylic acid. 

Describe the anatomic varieties of abdominal hernia. 

Oblique, or external inguinal : The hernia in all cases enters 
the inguinal canal through the internal abdominal ring, ex- 
ternal to the deep epigastric artery. This variety is called 
complete if it escapes through the external abdominal ring 
(scrotal hernia in the male, labial in the female) ; it is called 
incomplete (bubonocele) if it remains in the inguinal canal. 

Direct, or internal inguinal: The hernia gains entrance to 
the inguinal canal by passing through Hesselbach's triangle 
(bounded by edge of rectus, deep epigastric artery, and Pou- 



SURGERY. 321 

part's ligament). It does not pass through the internal 
abdominal ring, and the neck of the hernia is internal to the 
deep epigastric artery. 

Femoral: The hernia passes out of the abdominal cavity 
through the femoral canal and makes its appearance upon the 
thigh. 

Umbilical : The hernia passes through the umbilical ring. 

Obturator: The hernia passes through the obturator canal 
and may make its appearance upon the thigh. 

Sciatic : The hernia passes out of the pelvis through one of 
the sacro-sciatic foramina (usually through the greater) and 
makes its appearance at the lower border of the gluteus maxi- 
mus. The neck of the hernia is above the great sacro-sciatic 
ligament. 

Perineal : All hernias which protrude through the muscular 
floor of the pelvis toward the perineum are designated as 
perineal hernias. The neck of the hernia is below the great 
sacro-sciatic ligament. They receive special names according 
as to whether the skin, the vagina, or the rectum is pushed 
in advance of the hernial protrusion. 

Inguino-perineal (Coley) : A hernia associated with mal- 
descent of the testis. In these cases the testicle is in the 
perineum and the hernia follows the testicle. 

Diaphragmatic: The hernia protrudes through the dia- 
phragm. Many of these cases are not true hernias, as they 
have no sac of peritoneum. 

Ventral : The hernia appears at any portion of the anterior 
abdominal wall except the umbilicus. They are subdivided 
into epigastric hernia (in the median line above the navel), 
hernia of the linea alba (below the navel), and lateral ventral 
hernia. 

Lumbar : A hernia making its appearance in the lumbar 
region. It is commonly taught that it passes through Petit 's 
triangle, but no such instance has ever been proved by dis- 
section (Sultan). In some instances it passes through 
Braun's space. 

Internal hernias : 1. Hernia through the foramen of Wins- 
21 



322 SURGERY. 

low. 2. Hernia through the duodeno- jejunal recess (retro- 
peritoneal). 3. Hernia through the retro-cecal and ileo-cecal 
recesses (retro-peritoneal). 4. Hernia through the inter- 
sigmoid recess (retro-peritoneal). 5. Retro-vesical hernia. 
The lateral vesico-umbilical fold is so markedly developed 
that a peritoneal pocket is produced at one side. 

Describe the symptoms and give the treatment of hem= 
orrhage from the middle meningeal artery. 

Symptoms: The first symptoms are those of concussion. 
These are followed by a temporary return of consciousness 
(very important) and the gradual onset of coma within 24 
hours, usually without any rise in the temperature. Since 
the blood clot presses upon the motor area, localized twitch- 
ings or paralyses may be present. The paralysis is apt to be 
progressive, commencing in the face and then extending to 
the arm and leg. If the clot gravitates toward the base the 
pupil of the same side will be dilated and immobile ; if on the 
left side aphasia will be present, the pulse will be frequent, 
the respiration slow and stertorous, and the temperature will 
rise to 101° to 103° (or even higher) upon the side opposite 
the clot. 

Treatment: The anterior branch of the middle meningeal 
is the one commonly involved, but the posterior may also be 
the source of the bleeding. After all aseptic precautions 
have been carried out, a semicircular flap is turned down and 
the skull trephined. The pin of the trephine is placed upon 
a point one and one-fourth inches behind the external angular 
process at the level of the upper border of the orbit (anterior 
branch). If the clot is not found the trephine should be 
immediately reapplied just below the parietal eminence at 
the same level as the first opening (posterior branch). The 
clot should now be removed, the trephine opening being en- 
larged with rongeur forceps if necessary, and the cavity 
thoroughly irrigated with sterile water. If the artery is still 
bleeding it should be tied by passing a cat-gut ligature through 
the dura and about the artery by means of a Hagedorn needle. 






SURGERY. 323 

Drainage should be provided for and the wound closed in the 
ordinary manner. If there is evidence that the clot is gravi- 
tating toward the base, the first trephine opening should be 
made at a point one-half inch lower than that above given. 

Give symptoms and treatment of fracture of the nasal 
bones. 

Symptoms: Crepitus, deformity (depression or lateral dis- 
placement), preternatural mobility, swelling, and ecchymosis. 
Severe epistaxis, surgical emphysema, and cerebral symptoms 
are occasionally encountered. 

Treatment: Reduction at the earliest possible moment in 
order to avoid the persistence of the deformity. It is best 
to give an anesthetic, as these parts are exceedingly sensi- 
tive, and the reduction should be accurate and deliberate. 
The fragment is best returned to its proper position by a 
padded dressing forceps carried well up into the nose and 
assisted by external manipulation. Should there be any 
tendency toward a recurrence of the displacement the nasal 
chamber should be carefully packed with sterile gauze and 
the packing renewed every 24 hours. 

Describe the steps in the operation of stretching the 
facial nerve. 

After all aseptic precautions have been observed, an inci- 
sion is made commencing behind the pinna opposite the ex- 
ternal auditory meatus and extending downward and forward 
behind the lobule of the ear to the angle of the jaw. This 
incision divides the skin, superficial fascia, superficial layer 
of the deep fascia, and branches of the auricularis magnus 
nerve. The flaps are now dissected from the parotid gland, 
sterno-mastoid muscle, and mastoid process, care being taken 
to avoid the posterior auricular nerve, vein, and artery. The 
internal jugular vein is close to the posterior margin of the 
wound. After the parotid gland has been separated from 
the mastoid process the trunk of the nerve is found lying on 
the styloid process just above the posterior belly of the digas- 
tric muscle. The nerve is stretched by lifting it up with a 



324 SURGERY. 

blunt hook. The external incision is sutured and an anti- 
septic dressing applied. 

How would you expose the brachial artery for ligation 
in the middle of the arm? 

After all aseptic precautions have been observed, an inci- 
sion is made along the inner edge of the biceps muscle. The 
line of the artery is from a point just to the inner side of the 
center of the clavicle to midway between the two condyles. 
The incision divides the skin, superficial fascia, twigs of the 
internal cutaneous nerves, and small branches of the superior 
profunda and anterior circumflex arteries. The deep fascia 
is now divided and the inner edge of the biceps recognized. 
The arm should be held at right angles to the body and not 
allowed to rest upon any support, since the triceps muscle 
would displace the biceps and our muscular guide would be 
lost. The biceps is now displaced outwards and the pulsa- 
tions of the artery sought for. The median nerve generally 
lies over the artery in this position of the arm. It should be 
drawn inward and the sheath of the vessel opened. 

Give the treatment of foreign bodies in the trachea. 

The performance of a low tracheotomy, a sufficiently exten- 
sive opening being made in the trachea. If the foreign body 
cannot be removed at the time of the operation, by means of 
delicate forceps, coin-catcher, wire loop, or hooked probe, the 
edges of the tracheal wound should be sutured to the cuta- 
neous incision, and the foreign body, if movable, will usually 
be spontaneously expelled. If the foreign body is not ex- 
pelled within a day or two, the trachea and bronchi should 
be examined with a long probe. This excites violent cough- 
ing, which may dislodge the foreign body. The patient may 
be also inverted and simultaneously struck upon the back at 
the level of the tracheal bifurcation (fourth dorsal vertebra). 

Describe a method of differentiating between (a) the 
urethra, (b) the bladder, and (c) the kidneys as the sources 
of pus in the urine. 

Urethra : It is usually stated that if the urine is passed into 



SURGERY. 325 

two beakers, the first quantity will be turbid and the second 
one clear. If the pus originates in the posterior urethra, 
however, it regurgitates into the bladder and both specimens 
will be turbid. (Finger.) The urine will usually be acid, 
the pus will be in small quantities, and there will be signs of 
the local inflammation . 

Bladder : The freshly drawn urine will be alkaline, and may 
contain crystals of triple phosphate. The urine is increased 
in amount, and the last portions passed contain ropy, thick 
mucus. It may be possible to identify bladder cells in the 
sediment, and the pus corpuscles are said to be better formed 
than when they originate in the kidney. 

Kidney: In pyonephrosis the discharge of pus may be 
intermittent, clear specimens being obtained for days or even 
weeks. In calculous and tubercular pyelitis the pyuria is 
usually continuous. The pus is more intimately mixed with 
the urine than when it originates in the bladder or urethra, 
and the urine is acid in reaction. 

In all three instances the history of the case will be of 
value. 

Describe in detail the condition known as talipes equino= 
varus. 

In the affection known as talipes equino-varus the heel is 
drawn up and the anterior half of the foot is adducted and 
drawn inwards. The inner border of the sole is concave, and 
traversed by a sulcus corresponding to the position of the 
mid-tarsal joint; the outer border is convex, and this con- 
vexity is usually covered by a bursa. The sole of the foot is 
arched from secondary contraction of the plantar fascia and 
some of the plantar muscles (particularly the abductor hal- 
lucis), and its center may be marked by a longitudinal crease 
due to a folding over of the outer metatarsal bones. The 
individual walks upon the outer border of the foot, and, in 
neglected cases, even upon the dorsal aspect of the cuboid 
bone. 

In acquired cases the extensor and perineal muscles are 
paralyzed, and the tibialis anticus, tibialis posticus, flexor 



326 SURGERY. 

longus digitorum, and the tendo-Achillis are secondarily 
shortened. 

The astragalus is displaced forwards and outwards, and is 
the most deformed of all the tarsal bones. The neck of the 
bone is elongated, and the angle between the neck and the 
body, instead of being 35 degrees (child) or 10 degrees 
(adult), is increased to 50 degrees or even more. The sca- 
phoid is pushed to the inner side of the astragalus, the tuber- 
osity approaching or even touching the internal malleolus. 
The ligaments on the inner side of the foot are contracted 
(anterior portion of deltoid, inferior calcaneo-scaphoid, long 
and short plantar ligaments). 

What means has the surgeon at his command for the 
separation of tissues? 

Knife (scalpel, bistoury, tenotome), scissors, thermo-cau- 
tery, ecraseur, snare, elastic constriction, saw, trephine, 
chisel, osteotome, and the osteoclast. 

Describe talipes equinus and give its treatment. 

In the affection known as talipes equinus the heel is drawn 
up so that the patient walks upon the metatarso-phalangeal 
joints and the toes. The degree of deformity ranges from 
those cases in which there is simply a slight elevation of the 
heel to those in which the foot is almost vertical, and the 
plantar muscles and fascia so contracted that the patient 
walks upon the heads of the metatarsal bones, the toes being 
in a position of hyperextension (or even of hyperflexion) . 

Treatment : The milder cases may be treated by means of 
Sayre's apparatus, but subcutaneous division of the tendo- 
Achillis is usually required. The foot is subsequently placed 
in its normal position and put in plaster of Paris. The foot 
is kept in plaster for three months, and a mechanical support 
(rendering extension beyond a right angle impossible) should 
be worn for a year. In severe cases it may be necessary to 
divide the plantar fascia and elongate the tendo-Achillis by 
splicing. In the most obstinate cases some surgeons excise 
the astragalus. 



SURGERY. 327 

What are the symptoms of a foreign body in the stom= 
ach? Give the treatment. 

The symptoms of a foreign body in the stomach are fre- 
quently most obscure. There may be a sensation of weight 
and distress, and if the object is rough and irritating there 
may be local tenderness and vomiting of blood-tinged fluid. 
The X-ray will usually furnish valuable aid. 

Treatment : If the foreign body is small, non-irritating, and 
capable of being passed per rectum, the patient should be 
made to eat large quantities of foods leaving a considerable 
residue. If the foreign body will not pass the pylorus it 
should be removed by gastrotomy. 

What are the causes of acute prostatitis? Describe a 
typical case of acute prostatitis and give the treatment. 

Causes: Urethritis (usually gonorrheal), traumatism, strict- 
ure, retention of decomposing urine, prostatic calculi, and 
cystitis. 

Symptoms : Deep-seated pain, accompanied by a sensation 
of heat and weight in the perineum. The desire to pass water 
is frequent and micturition is painful, particularly at the 
conclusion of the act. Defecation is painful, and digital 
examination per rectum reveals a hot and exquisitely tender 
swelling of the prostate gland. The perineum is also hot and 
tender. The patient cannot sit comfortably, but will support 
his weight upon one buttock to avoid any pressure upon his 
perineum. If suppuration occurs, as is usually the case, the 
pain becomes more marked and of a throbbing character, the 
perineum becomes red and edematous, retention of urine may 
occur, and the passage of a catheter causes excruciating pain, 
Fever is present, and there may be a marked chill. The 
abscess may discharge through the urethra, rectum, perineum, 
or above Poupart's ligament. 

Treatment : Absolute rest in bed, and a bland, non-irritating 
diet. The bowels should be kept loose to avoid the pressure 
of hardened feces upon the inflamed organ. Hot hip baths 
sometimes cause a marked diminution of the pain. If the 



328 SURGERY. 

ease is seen early, leeches followed by hot fomentations should 
be applied to the perineum. If the pain is intense, supposi- 
tories of morphin and belladonna should be given. If reten- 
tion is present the urine should be drawn off with a small 
rubber catheter. If suppuration has occurred the passage of 
the catheter will occasionally rupture the abscess, which may 
then evacuate itself through the urethra. If this does not 
occur, and there are evidences of deep-seated suppuration, 
or if the pus does not discharge freely, the patient should be 
etherized and placed in the lithotomy position. The finger 
is now introduced into the rectum and an incision made in 
the median line of the perineum down to the seat of pus for- 
mation. The abscess cavity is then evacuated, irrigated, and 
a drainage tube introduced. 

Give the course, symptoms, and treatment of varicocele. 

Course: The affection appears in early adult life (rarely 
after 35) , and is practically always upon the left side, vari- 
cocele of the right side alone being almost unheard of. In 
many cases it persists throughout life without any injury to 
the individual, while in some cases it may lead to atrophy of 
the testicle. 

Symptoms : A swelling situated along the spermatic cord 
and feeling like a bunch of earth-worms. The swelling is 
compressible, gives an impulse upon coughing, disappears 
when the patient lies down, and reappears when he stands up, 
even though firm pressure is made over the site of the external 
ring. In most cases the scrotum is relaxed and flabby, and 
there may be a sensation of dragging weight, or even of actual 
pain. The testicle upon the affected side may be smaller or 
flabby, but it is nearly always perfectly healthy. Many indi- 
viduals with this affection worry themselves into a condition 
of mental disquietude out of all proportion to the local dis- 
ease. 

Treatment, Palliative : A well-fitting suspensory bandage. 

Operative: Operative treatment is to be adopted if the 
patient desires to enter the army or navy, if the affection 



SURGERY. 329 

causes physical discomfort despite the wearing of a suspen- 
sory, and if the mental condition of the patient cannot be 
relieved until the varicocele is removed. The operation for 
the cure of varicocele consists of the excision of a section of 
the dilated veins. The incision is to be made in the groin, 
and not in the scrotum, as was formerly practiced. About 
two inches of the cord is drawn up through the incision, the 
vas deferens (feels like a "whip-cord") and its accompany- 
ing vessels are carefully isolated and not included in the 
double ligature (chromicized cat- gut ) . The ligatures are 
placed at a distance of from one to two inches from each 
other and the intervening bundle of veins is removed. One 
end of each ligature is cut short, and the other ends are tied 
so that the cord is shortened and the testicle elevated. To 
insure accurate apposition of the two stumps it is well to 
insert one or two sutures of fine cat-gut. All hemorrhage 
must be thoroughly arrested to insure the best results. The 
testicle is now drawn down into the scrotum and the cuta- 
neous incision sutured in the customary manner. 

Describe McBurney's " grid=iron " incision for appen= 
dicitis. What is the advantage of this incision and what 
is the disadvantage? 

After the skin has been carefully disinfected, an oblique 
incision about three inches in length is made, commencing 
one inch above McBurney's line and crossing this line about 
an inch and a half internal to the anterior superior spine. 
The position of the incision will naturally vary somewhat 
according to the location of the swelling, but it should always 
be made in the direction of the fibres of the external oblique 
muscle. The aponeurosis of the external oblique and a small 
portion of the muscle itself are now divided in the direction 
•of the external incision. The fibres of the external oblique 
muscle should be separated (not incised), great care being 
taken that none of the fibres are divided transversely. Re- 
tractors are now placed in the wound and the internal oblique 
and the transversalis muscles are similarly split in the direc- 



330 SURGERY. 

tion of their fibres. The transversalis fascia and peritoneum 
are then divided in the usual manner. 

The advantage of the incision is that the abdominal wall is- 
not weakened as much as if the muscular fibres were cut 
across, and therefore there is consequently less tendency to 
subsequent ventral hernia. 

The disadvantage of the incision is that the amount of 
room to work in is somewhat lessened, and the performance 
of the operation consequently rendered more difficult. 

What is the difference between congestion and inflam- 
mation? 

Arterial congestion is an excess of blood in the more or less 
dilated arteries of a part, the velocity of the blood-current 
being increased. The part is reddened, the temperature is- 
increased, swelling is scarcely appreciable, pain is not present, 
except that the patient may complain of a throbbing sensa- 
tion, and the function and nutrition of the part are increased. 
If the congestion continues the part becomes either hyper- 
trophic or inflamed. 

"Inflammation is the succession of changes which occur in 
a living tissue when it is injured, provided that the injury is 
not of such a degree as to at once destroy its structure and 
vitality." (Burdon Sanderson.) The part is reddened, the- 
temperature is increased, swelling may be considerable, and 
pain is present dependent upon the character of the tissue- 
involved and the severity of the inflammation. The function 
of the part is diminished and fever is usually present. 

How would you diagnose and treat a case of fracture of 
both bones of the forearm occurring at the middle third? 

The diagnosis is usually apparent at a glance. There will 
be angular deformity, as a rule, crepitus, a new point of 
motion (preternatural mobility), pain, and subsequently- 
swelling and ecchymosis. The power of supination and pro- 
nation is entirely lost. In those cases in which the diagnosis 
might be doubtful the X-ray will reveal the nature of the- 
lesion. 



SURGERY. 331 

Treatment: Reduction by extension and counter-extension 
combined with manipulation at the site of the fracture. 
After the deformity has been reduced the forearm should be 
kept flexed at a right angle to the arm and in a position 
midway between pronation and supination (thumb up!). 
Two splints should be applied, a palmar extending from the 
bend of the elbow to below the wrist. The splints should be 
firmly and evenly padded, and must be broad enough to pre- 
vent circular constriction of the forearm. A primary, roller 
should never be applied, and an interosseous pad is not to be 
employed. Union is usually complete in four or five weeks. 

Define amputation in the continuity and amputation in 
the contiguity of a limb. 

By amputation in the continuity of a limb is meant an 
amputation through the bone or bones of the extremity. 

By an amputation in the contiguity of a limb is meant an 
amputation through any of the joints of the extremity. 

Define the following terms: (a) Bursitis; (b) bunion; 
(c) paronychia. Give the treatment for each disease. 

By bursitis is meant the inflammation of a bursa. 

By a bunion is meant an inflammation of one of the bursa? 
about the foot, usually over the metatarsophalangeal joint 
of the great toe. 

By paronychia or felon is meant an inflammation of a fin- 
ger. It may be subcuticular, subcutaneous, thecal (suppur- 
ative teno-synovitis), or subperiosteal (bone felon). 

Simple acute bursitis is treated by keeping the part at rest 
and the application of fomentations. If the effusion per- 
sists it may be aspirated or the entire cavity may be excised. 
Suppurative bursitis should be treated by early and free 
incision and the subsequent maintenance of effective drain- 
age. Chronic bursitis may be met by rest and counter-irri- 
tation; if these measures fail the bursa should be dissected 
out. Special care must be exercised in dealing with bursa? 
which communicate with a joint. In tuberculous bursitis 
the part should be freely incised, the tubercular tissue 
scraped away, and the cavity packed with iodoform gauze. 



332 SURGERY. 

The treatment of bunion is that of acute or of suppurative 
bursitis. If the bone is diseased it must be removed, and any 
malposition of the toe corrected during the period of conva- 
lescence. In some cases the underlying joint must be re- 
sected. 

All varieties of paronychia are best treated by a free and 
early incision extending well into the inflamed area. In the 
subcuticular and subcutaneous varieties care must be taken 
not to incise the sheaths of the tendons and thus give rise to 
additional infection. In the subperiosteal whitlow, the inci- 
sion should go down to the bone, and cannot be made too early. 

Describe the various steps in the operation of inguinal 
colostomy. 

After all aseptic precautions have been observed, an inci- 
sion about two inches in length is to be made, one and one- 
half inches above and parallel with the outer portion of 
Poupart's ligament. This incision should be carried down 
to the peritoneum. All hemorrhage having been checked, 
the parietal peritoneum is to be incised for about two-thirds 
the length of the external wound and accurately stitched to 
the skin. While this step of the operation is being performed 
the intestines should be held out of the way by a sterile gauze 
pad. After the colon has been found it should be drawn out 
of the wound, pulling from above downward, and returning 
the protruding bowel through the lower angle as it is drawn 
out from the upper one. As soon as the colon is almost taut, 
an opening is made in the meso-sigmoid (or descending meso- 
colon, as the case may be) and a glass rod passed through it 
so as to bring a coil of intestine out of the wound, the ends of 
the rod resting upon the skin. The two limbs of the intes- 
tinal coil are fixed by suturing them together beneath the 
glass rod. An aseptic dressing is now applied. Adhesions 
will be sufficiently firm by the third or fifth day, when the 
intestine may be opened by a transverse incision. This latter 
step may be performed without an anesthetic. A few days 
later all of the bowel projecting above the skin may be cut 
away and the bleeding carefully checked. Should it be neces- 



SURGERY. 333 

sary to open the bowel immediately, the intestine should be 
accurately sutured to the lips of the cutaneous incision and 
a Paul's tube tied in place. 

Describe an operation for wry=neck. 

Open myotomy of the sterno-cleido-mastoid muscle. All 
aseptic details having been observed, the skin is freely incised 
about a half inch above the clavicle, and the sterno-cleido- 
mastoid muscle is freely divided at the level of the cutaneous 
incision, the external wound is closed, and an aseptic dressing 
is applied. The faulty position of the head is then over- 
corrected and fixed in its new position by a plaster of Paris 
bandage or other suitable contrivance. 

What are the causes of dysphagia? 

1. Pharyngeal: Acute or chronic inflammation, tubercu- 
losis, syphilis, malignant growths, stricture, paralysis, naso- 
pharyngeal polypi, impaction of foreign bodies, and retro- 
pharyngeal abscess or tumor. 

2. Laryngeal: Acute or chronic inflammation, tuberculosis, 
syphilis, or malignant growths. 

3. Esophageal : Acute or chronic inflammation, impaction 
of foreign bodies, the presence of diverticula, esophagospasm, 
and simple or malignant stricture. 

4. Extrinsic causes : Aneurysm, goitre, enlarged glands, 
mediastinal growths, pericardial effusion, tumors growing 
from the bodies of the vertebra, and backward dislocation of 
the sternal end of the clavicle (modified from Rose and Car- 
less). 

What are the varieties of arteriovenous aneurysm and 
state their points of difference. 

An arterio-venous aneurysm is either an aneurysmal varix 
or a varicose aneurysm. 

An aneurysmal varix is a direct communication between 
an artery and a vein without the interposition of a sac. 

A varicose aneurysm is an indirect communication between 
an artery and a vein with the interposition of a sac. 



334 SURGERY. 

Give the main points of difference between acromegaly, 
ostitis deformans, and leontiasis ossea. 

Acromegaly occurs in young adults (20-30). It affects the 
bones of the hands and feet and those of the face (particu- 
larly the lower jaw and the nasal bones) . The cranial bones 
are not affected, with the exception of the lower portion of 
the frontal bones and the margins of the orbits. The bones 
of the hands and feet are broader, but there is no increase in 
their length. Microscopically the osseous structure does not 
differ from that of normal bone. 

Ostitis deformans begins more commonly in men past mid- 
dle life. It affects the long bones of the extremities and the 
bones of the cranium. The facial skeleton shows little 
change. Kyphosis is present. Pain is present in the early 
stages of the disease, but, unlike other bone pains, it is not 
worse at night. The affected long bones are increased in 
length. The microscope reveals changes similar to those of 
rarefying ostitis. 

Leontiasis ossea begins in early life, and the extremities are 
not affected. Both the facial and the cranial bones are in- 
volved, the bones of the jaws first becoming enlarged. 

Give the treatment for mammary carcinoma. 

The treatment of mammary carcinoma consists of the earli- 
est possible removal of the entire breast, together with the 
axillary and supraclavicular glands. All these structures 
should be removed in one continuous piece, so that no infected 
lymphatic vessel is divided. Advanced cases may require the 
removal of the sternal portion of the pectoralis major and of 
the pectoralis minor, and in such cases the entire mass re- 
moved should also be in one piece. The sharpest knife ob- 
tainable should be used. The first thought in the mind of the 
surgeon should be to remove all of the cancerous tissue, the 
closure of the wound being a consideration of secondary 
importance. Adequate drainage should be provided, and 
skin grafting should be resorted to if sufficient cutaneous 
covering cannot be safely left to close the wound. Those 



SURGERY. 333 

^cases are to be regarded as inoperable in which the disease is 
no longer local. Palliative operations may be performed for 
the relief of pain in certain well selected cases. 

Describe the various steps in amputation at the wrist by 
a long palmar flap. 

After all aseptic precautions have been observed, the hand 
is supinated, the thumb is abducted, and an incision is made 
commencing at the styloid process of the radius and extend- 
ing over the thenar eminence to the distal transverse palmar 
crease. This incision is continued transversely across the 
palm and then up over the hypothenar eminence to the styloid 
process of the ulna. This flap is now dissected away from 
the bones, and contains all of the structures of the palm; the 
flexor tendons and large nerves should be divided at the level 
of the wrist joint and removed. The hand is then placed in 
the pronated position and a slightly curved incision is made 
connecting the two styloid processes, the convexity of the 
incision being directed downward. The extensor tendons 
and the lateral and posterior ligaments of the wrist are 
divided and the hand removed. After all hemorrhage has 
been checked the palmar flap is brought over the ends of the 
bones and held in position by interrupted sutures of silk- 
worm-gut. An aseptic dressing is then applied. 

How does ulceration differ from mortification? 

By ulceration is meant the molecular death of a part; by 
mortification (or gangrene) is meant molar death or the 
death of the part en masse. 

Differentially diagnose phimosis and gonorrhea from 
phimosis and subpreputial chancroid. 

In phimosis and gonorrhea there is no history of a sore on 
the glans or prepuce, the preputial swelling is at first simply 
edematous, the discharge is usually purulent, there is no local- 
ized area of hardness or tenderness, chordee is frequently 
present, the ardor urinse is felt along the entire urethra, 
vesical symptoms are not uncommon, and bubo is very rare. 

In phimosis and subpreputial chancroid there is a history 



336 SURGERY. 

of a sore, the preputial swelling is due to a plastic exudate 
about the ulcer, the discharge is frequently bloody, a localized 
area of hardness or tenderness is usually present, true chordee 
never occurs, the ardor urinse is experienced only when the 
urine comes in contact with the ulcerated foreskin, vesical 
symptoms are absent in uncomplicated cases, and bubo is 
common. 

Describe Bassini's operation for the radical cure of ob= 
lique inguinal hernia. 

After all aseptic details have been observed, an incision is 
made parallel to and one-half inch above Poupart's ligament. 
This incision extends from above the center of Poupart's lig- 
ament to the base of the scrotum, and exposes the aponeurosis 
of the external oblique and the external abdominal ring. All 
hemorrhage having been checked, a grooved director is carried 
into the inguinal canal, and the aponeurosis of the external 
oblique is divided to a point well above the internal abdominal 
ring. The upper flap of aponeurosis is freed until the arching 
fibres of the conjoined tendon come into view ; the lower flap 
is drawn down until the shelving edge of Poupart's ligament 
is exposed. The sac is now separated from the cord (the cord 
usually being behind the sac), and this separation is carried 
up to the internal ring. The sac is opened, adhesions prop- 
erly dealt with, omentum ligated in sections, and the intestine 
returned to the abdominal cavity. The sac is then ligated at 
a point high up, just above the internal ring, and the redund- 
ant portion cut off about a centimetre below the ligature. 
The cord is now held up out of the wound by a strip of sterile 
gauze, and the conjoined tendon sutured to the deep shelving 
of Poupart's ligament by four or five sutures. It has been 
advised to place one suture above the cord, as this is the point 
at which the recurrence is most likely to occur. None of these 
sutures should be tied too tightly, as strangulation of the 
tissues greatly favors infection and interferes with primary 
union, which is absolutely essential to the success of the 
operation. The cord is now laid upon its newly-formed bed 
(after resection of some of the veins if necessary), and the cut 



SURGERY. 33T 

edges of the aponeurosis of the external oblique are united 
by a continuous suture. Great care should be taken to pre-. 
vent any suture interfering with the circulation in the cord. 
The cutaneous wound is then closed with a subcuticular stitch 
and an aseptic dressing applied. The deep sutures should 
consist of kangaroo tendon, the superficial ones of chromi- 
cized cat-gut. If the operator is not sure of the asepticity of 
the tendon or cat-gut, silk sutures should be employed. 

Give the differential diagnosis of abscess. 

If an abscess is present there will be a history of a preced- 
ing inflammation, fluctuation, a tendency to point, an absence 
of thrill, an absence of bruit, a febrile temperature (as a 
rule), and an examination of the blood usually reveals a poly- 
morphonuclear leukocytosis. If the abscess Kes over a blood- 
vessel it may have an up and down pulsation, but if the 
abscess is pushed to one side this pulsation ceases. In such a 
case the abscess will not change in size if pressure is made 
upon the vessel above or below the abscess. The exploring 
syringe reveals pus. 

Aneurysm: If an aneurysm is present there will be no his- 
tory of a preceding inflammation, fluctuation is rare, the 
swelling preserves its fusiform or rounded shape, showing no 
tendency to point, thrill and bruit are present, the pulsation 
is expansile, the swelling cannot be moved from the line of 
the blood-vessel, pressure above the aneurysm decreases its 
size and expansile force, pressure below the aneurysm in- 
creases its size and expansile force, there may be a difference 
in the pulse to the distal side of the aneurysm as- compared 
with the corresponding vessel upon the opposite side, and 
leukocytosis and fever are absent (unless the sac is inflamed). 
The exploring syringe reveals blood. 

Cysts : The overlying tissues are not edematous, nor is there 
a history of a preceding inflammation. The exploring syringe 
is of value in doubtful cases. 

Tumors : The only tumor apt to be confused with an ab- 
scess is a rapidly growing sarcoma (small round cell). Al- 
though these tumors may fluctuate, inflammatory symptoms, 
are absent, and the exploring syringe reveals a bloody fluid. 
22 



338 SURGERY. 

Describe intermediate and secondary hemorrhage, giv- 
ing both preventive and curative treatment of each. 

By intermediate hemorrhage is meant a hemorrhage recur- 
ring within twenty-four hours of an accident or operation. 

Preventive treatment: The proper method of tying the 
ligatures (surgeon's knot), which should include the artery 
alone, and not the surrounding tissues. All bleeding points 
should be carefully and completely controlled at the time of 
the accident or injury, and stimulants should not be injudi- 
ciously employed. 

Curative treatment: Elevation and pressure. If these 
measures are not successful, the wound should be opened up, 
irrigated with hot sterile saline solution, and all bleeding 
points tied. If ligatures cannot be applied, the actual cau- 
tery may be employed, or the wound may be packed with 
antiseptic gauze. 

By secondary hemorrhage is meant any hemorrhage occur- 
ring in a wound after the lapse of twenty-four hours from 
the time of the injury or operation. 

Preventive treatment: Thorough asepsis, the proper appli- 
cation of ligatures to all bleeding points, and the avoidance 
of the injudicious use of stimulants. 

Curative treatment: This will depend upon whether the 
hemorrhage comes from the end of a divided artery (as in a 
stump) or whether it comes from an artery which has been 
ligated in its continuity. 

If the hemorrhage comes from the end of a completely 
divided artery (as in a stump), elevation, exposure to the air, 
irrigation with hot sterile saline solution, and firm bandaging 
may suffice in the milder cases. If the hemorrhage recurs, 
the wound must be opened again, and the bleeding points 
ligated. If ligatures cannot be employed on account of the 
septic condition of the tissues, the actual cautery will be of 
service. All septic sloughs should be removed by the Volk- 
mann spoon, and the wound swabbed out with carbolic solu- 
tion (1-20) or with a solution of chloride of zinc (1-12). 
The wound should then be dusted with iodoform crystals, 



SURGERY. 339 

firmly packed with iodoform gauze, and a firm bandage 
applied. If the secondary hemorrhage occurs later in the 
case, the wound must be opened up, the bleeding vessel iso- 
lated from the surrounding structures, and ligated higher up. 
If this is impossible, the artery must be ligated still higher 
up, or a re-amputation performed. If the secondary hemor- 
rhage occurs after a shoulder or hip amputation, proximal 
ligation is the only measure to rely upon should the local 
treatment fail. 

If the hemorrhage comes from an artery which had been 
ligated in its continuity, the same local treatment should be 
adopted as in the former instance. If this is unsuccessful, 
the treatment will depend upon the situation of the vessel. 
If the vessel is in the trunk (iliac) or neck (carotid) the 
wound must be opened up, the artery again ligated above and 
below, and the septic condition of the tissues combatted by 
packing with antiseptic gauze. If this fails, and proximal 
ligation is impossible, pressure will be the last resort. In 
the arm, if cold, pressure and elevation are without effect; 
the original wound must be enlarged, and the vessel tied 
above and below. If the hemorrhage still continues, the 
artery must be exposed and ligated higher up through an 
independent incision, or amputation will have to be per- 
formed. In the leg, a second ligature at a higher point is of 
questionable value on account of the poorer collateral circu- 
lation. Should it control the hemorrhage, gangrene will re- 
sult, and consequently amputation should at once be per- 
formed if the local measures are unsuccessful. 

State the differences between sthenic and asthenic in» 
flammatory fever. 

Sthenic inflammatory fever occurs in the young and in the 
robust. It rarely commences with a chill, the temperature 
rises to 102 degrees or 103 degrees F., delirium if present is 
maniacal, the pulse is full and strong, the skin is hot and dry, 
and constipation is present. 

Asthenic inflammatory fever occurs in the aged and in the 
debilitated. It usually commences with a chill, the temper- 



340 



SURGERY. 



ature rises to 104° or 105° F., the delirium is low and mutter- 
ing, the pulse is rapid and weak, the skin is cold and clammy, 
and diarrhea is present. 

Differentiate dislocation of the head of the femur from 
fracture of its neck, and give main essentials of treatment 
of each. 

Intracapsular Fracture. 

Eversion of foot. 

Preternatural mobility. 

Head of femur felt in its natural 
position. 

Flattening of hip, the great trochanter 
moving in im arc of smaller radius, 
and relaxation of the ilio-tibial 
band. 

Crepitus may be elicited (unless im- 
paction is present). 

Immediate shortening of a half-inch, 
consecutive shortening of two or 
three inches. 

Much more common in advanced life 
and in the female. 

Violence usually trivial. 



Dorsal Dislocation. 

Inversion of foot. 

Immobility. 

Head of femur not felt, in its natural 
position. 

The buttocks of the affected side are 
unduly prominent, due to the pres- 
ence of the head of the dislocated 
bone. 

Crepitus is absent. 

Immediate shortening of two or three 
inches. 

Earely occurs after forty-five, and 

more commonly in the male. 
Violence usually coLsiderable. 



Treatment. 



Reduction by flexion of leg upon 
thigh (for leverage), flexion of 
thigh upon abdomen (to relax Y- 
ligament), external circumduction, 
and extension. When reduction 
has been effected, the knees should 
be bandaged together, and the pa- 
tient kept in bed for two weeks. 



Reduction by extension and counter- 
extension. Buck's extension should 
be permanently employed. A sand- 
bag extending from the axilla to 
the external malleolus should then 
be placed upon the outer side of 
the extremity, and one extending 
from the groin to the internal mal- 
leolus upon the inner side of the 
extremity. 

In some cases it may be advisable to 
apply a plaster cast over the abdo- 
men and over the injured extremity 
to below the knee, and to allow the 
patient to change her position. In 
other cases the general condition of 
the patient makes it imperative to 
absolutely disregard the fracture. 



SURGERY. 341 

Describe a method of amputation of the thigh. 

The method giving the best results will generally be a flap 
amputation through the skin and a circular amputation 
through the muscles (mixed method). After all aseptic pre- 
cautions have been observed, and a tourniquet properly ap- 
plied, the surgeon takes his position upon the right side of the 
extremity to be amputated and makes a straight incision upon 
either side of the thigh. These incisions commence at the 
level at which the bone is to be divided; they are as long as 
the diameter of the limb at their point of origin, and they 
divide the skin and subcutaneous connective tissue. The 
lower ends of these incisions should be connected by a trans- 
verse cut of similar depth, and the corners of the flap rounded 
off. The centers of the two incisions should now be joined 
by a posterior transverse incision, the corners being rounded 
off as before. The anterior flap is now raised, and consists of 
nothing but skin and subcutaneous fat, excepting at its base, 
where a certain amount of muscular tissue should be included. 
The posterior flap is then dissected up, and should consist of 
nothing but skin and subcutaneous fat throughout. The 
muscles are now to be divided by a circular sweep of the knife. 
An assistant retracts the muscular tissue, a cuff of periosteum 
is raised, and the bone is sawn through as high up in the 
wound as possible (about one and one-half inches above the 
angles of junction of the flaps). After the main vessels have 
been secured the tourniquet should be loosened and all bleed- 
ing points caught and ligated. Large nerves are drawn out 
and divided with scissors at the highest possible level, any 
projecting tendons are retrenched, and capillary hemorrhage 
is checked by hot sterile saline solution. The muscular tissue 
may then be sutured over the end of the bone if desired, and 
the edges of the flap united by interrupted sutures. The 
operation is concluded by the application of an aseptic 
dressing. 



PATHOLOGY AND BACTERIOLOGY. 



What are the characteristic features of diphtheritic exu- 
dation or infiltration of mucous membrane? 

The layers of mucous membrane undergo coagulation ne- 
crosis, and are infiltrated by a granular or fibrillar exudation 
of fibrin, and by leukocytes. 

What abnormal organic ingredients are found in the 
urine in chronic morbus Brightii? 

Tube casts — hyaline, granular or cellular; cylindroids, 
epithelial cells from urinary tubules, albumin, and at times 
leukocytes and erythrocytes. 

In what general respects do " anemia and progressive 
pernicious anemia " differ? 

Anemia refers to any blood impoverishment. Pernicious 
anemia is a very serious type of an essential anemia in which 
there is a disproportionate oligocythemia. In most anemias 
this is proportionate to the oligochromemia. 

What is cretinism, and with what is it associated? 

A disease developing in early life characterized by disten- 
sion (at times myxomatous) of subcutaneous tissues and by 
general mental and physical ill development, that is always 
associated with abnormality or absence of the thyroid gland. 

How should sputum be examined for tubercle bacilli? 

A selected portion of morning expectoration is thinly spread 
on a cover-glass, dried, fixed by heating, stained for three 
minutes in hot carbol-fuchsin, washed, decolorized and coun- 
ter-stained for one-half minute in Gabbet's solution, washed, 
dried, mounted in balsam, and examined under a one-twelfth 

(343) 



344 PATHOLOGY AND BACTERIOLOGY. 

oil immersion objective for minute red rods — the tubercle 
bacilli. 

Describe a tubercle bacillus. 

A minute non-motile, asporogenous, slightly curved rod 
with rounded ends, measuring about 2 x .5 micron. When 
stained it often appears beaded from irregularity in staining 
of protoplasm. 

What is infective inflammation? How does it differ 
from simple inflammation? 

Infective inflammation is that form due to the action of 
bacteria, while simple inflammation is not due to micro- 
organisms. Infective inflammation tends to spread, is more 
severe, and is often associated with marked constitutional re- 
action, the reverse being the case in simple inflammation. 

Give the morbid anatomy of acute lobar pneumonia. 

In engorgement (first stage) the affected lobe is deep red, 
boggy, slightly crepitant, and on section exudes bloody serum ; 
this passes into red hepatization (second stage), in which 
the affected lobe is dark red, solid, airless, friable, with dry, 
granular surface of section, while in gray hepatization (third 
stage) the lobe is grayish-white, solid, friable, with moister 
surface of section. Microscopically, in the first stage, there 
is intense hyperemia, with presence of serous liquid and red 
and white corpuscles in alveoli. In the second stage the air 
cells are filled by red and white corpuscles entangled in 
coagulated fibrin, while in the third stage the fibrin, erythro- 
cytes and hyperemia disappear and the alveoli are distended 
by leukocytes and granular detritus. Resolution (fourth 
stage) is characterized by liquefaction necrosis, absorption 
and expulsion of exudate. 

Give the causes and process of cerebral softening. 

' The chief causes are the obstruction of cerebral arteries by 
an embolus, thrombus or arterio-sclerosis. The area thus ren- 
dered anemic degenerates and undergoes colliquation necrosis, 
and if pyogenic bacteria are present an abscess may form. 



PATHOLOGY AND BACTERIOLOGY. 345 

Describe the rash and give the morbid anatomy of scar= 
latina. 

Scattered red points on a deep reddish base appear over 
neck and chest by the second day, spread over the body, and 
after three or four days gradually fade, to be followed by 
desquamation. There are no specific lesions, but usually 
acute catarrhal or pseudo-membranous pharyngitis, acute 
diffuse nephritis, and often follicular tonsillitis, lympha- 
denitis (at times suppurative), catarrhal gastro-enteritis, in- 
terstitial hepatitis, splenic enlargement, and as complications, 
purulent otitis media, endocarditis, pericarditis, broncho- 
pneumonia. 

What is a giant cell? Give characteristics. 

A very large cell with many nuclei, found in the tubercle, 
in gumma, in bone marrow, and in myeloid sarcoma. It is 
irregular, and often indefinitely outlined, with hyaline proto- 
plasm and from four to one or two hundred nuclei, that may 
be (as in tubercle) arranged peripherally, equatorially, at 
the poles or (as in sarcoma) near the center of the cell. 

Describe the formation of adipose tissue. 

In protoplasm of connective tissue cells, fat droplets that 
tend to coalesce and .displace the nucleus are deposited. 
Finally the nucleus is displaced to extreme periphery of cell 
and may disappear, while the cell is transformed into a dis- 
tended sac filled by fat. If this takes place, in many adja- 
cent connective tissue cells adipose tissue results. 

What changes take place in atrophic cirrhosis of the 
liver? 

A reduction in the size of the liver, an overgrowth of the 
interlobular connective tissue, a proliferation of interlobular 
bile ducts and fatty, parenchymatous or other degenerative 
-changes in the liver cells. 

How would you recognize amyloid degeneration? 

Dilute Lugol's solution turns it a mahogany-brown color. 



346 PATHOLOGY AND BACTERIOLOGY. 

What pathological changes occur in caries? 

In caries (rarefying ostitis) there is a solution of bone with 
or without the formation of pus. A round-celled infiltration,, 
often with the formation of granulation tissue, occurs in 
medulla and in Haversian canals with solution of soft and 
hard structure of bone, the ended pits being Howship's- 
lacunae. 

How is dental caries produced? 

Acids (especially lactic) formed by bacteria present in the 
saliva acting upon starchy particles, progressively dissolve 
the mineral structure of the tooth, whereupon saprophytic 
micro-organisms present cause solution of the organic sub- 
stance of the tooth. 

Describe catarrhal inflammation. 

An inflammation of a mucous surface, with the fluid exuda- 
tion consisting of mucus, serum, leukocytes and desquamated 
epithelial cells in varying proportions. The area affected is 
red, swollen and bathed by exuded secretion. 

What is the line of demarcation in gangrene? 

The zone of inflammatory reaction observed in the living 
tissue adjacent to the gangrenous area. 

What is the line of separation in gangrene? 

The narrow zone of progressive ulceration and molecular 
disintegration distal to the line of demarcation that tends to- 
sever the connection between the living and dead tissues. 

What postmortem changes occur in the tissues? 

Rigor mortis, algor mortis, livores mortis, muscular relaxa- 
tion, formation of adipocere, decomposition. 

Define atrophy. Give the varieties of atrophy. 

The diminution in size and functional capacity of a part. 
It may be simple or degenerative, passive, active, senile, pres- 
sure or neuropathic atrophy. 

Differentiate fatty infiltration and fatty degeneration. 

In fatty infiltration the fat is from without affected cells, 
and appears as fat droplets that coalesce, displace and obscure- 



PATHOLOGY AND BACTERIOLOGY. 347 

the nucleus, and distend, but do not entirely destroy, the cell. 
In metamorphosis the cell protoplasm is converted into fat 
that appears in the form of granules or minute droplets that 
tend to cause the breaking down and destruction of proto- 
plasm and nucleus. 

Define fibromata. Give the histology of fibromata. 

A tumor of the type of nbro-connective tissue, showing 
under the microscope whorls or curving bundles of long, nar- 
row fibers having occasional narrow spindle-shaped nuclei. 
As a rule, fibromas are encapsulated and not very vascular. 

What are the degenerative changes of arteries? 

Calcareous infiltration, hyaline, fatty and amyloid degen- 
eration. 

What pathologic changes may cicatrices undergo? 

Cicatricial contraction or distension, cicatricial keloid, 
cicatricial carcinoma, abscess and ulceration. 

What is ischemic paralysis? 

The loss of voluntary motion in a living part, the result of 
local anemia. 

Differentiate between a tubercular and typhoidal ulcer 
of the small intestine. 

The tubercular ulcer results from the action of the tubercle 
bacillus, is chronic, tends to have a long axis transverse (annu- 
lar ulcer) to bowel, to show outlying tubercles and irregularly 
thickened edges and base. The typhoid ulcer results from 
the action of the bacillus of Eberth, tends to have its long 
axis parallel to gut, to have undermined edges and thin floor. 
and often causes hemorrhage or perforation. 

Distinguish between burns inflicted on a body before 
death and those inflicted after death. 

Vesicles containing albuminous serum and an adjacent red 
zone of inflammatory reaction indicate infliction of burn dur- 
ing life, and are absent in case of burns produced after death. 



348 PATHOLOGY AND BACTERIOLOGY. 

Give the causes of hemorrhage. 

Increased blood pressure, atheroma, aneurysm, fatty, calca- 
reous, inflammatory change' or malignant infiltration of Vessel 
wall, embolism, traumatism, hemophilia, scurvy, typhus fever, 
venoms, phosphorous poisoning, and anomalous innervation, 
as in hysteria. , , r 

What are the causes of lymphorrhagia? 

Lymphatic obstruction or injury, as may result from 
trauma, pressure of neoplasms, aneurysms or inflammatory 
tissue, or obstruction by filaria or other parasites. 

How does calcareous degeneration of the arteries influ* 
ence the circulation? 

Increases arterial pressure and the work of heart, causes 
imperfect blood supply, at times leading to gangrene, and 
favors thrombosis and hemorrhage (hemiplegia). 

What are pyogenic bacteria? 

Schizomycetes capable of inaugurating suppuration. 

What changes take place in simple atrophy of the liver? 

A reduction in size, with preservation of general outlines, 
and without noteworthy increase of stroma, or degenerative 
change in the liver cells. 

Describe syphilitic gummata. 

Rounded, soft or firm, grayish or yellowish, circumscribed 
masses, from five mm. to several cm. in diameter, surrounded 
by an area of fibro-connective tissue, and consisting of atyp- 
ical granulation tissue showing mucoid degeneration or central 
caseous necrosis. 

What changes characterize inflammation of bone? 

An absorption of bone, with the ingrowth of new granu- 
lation tissue (rarefying ostitis) or possibly abscess forma- 
tion, or a progressive ossification with resulting thickening 
and condensation (condensing ostitis). 



PATHOLOGY AND BACTERIOLOGY. 349 

Where and what are the pathologic changes in bulbar 
paralysis? 

Degenerative atrophy and sclerosis, with shrinking of 
motor cells and degeneration of processes, affecting the glosso- 
labio-laryngeal nucleus in the medulla. 

Give the pathologic changes in sclerosis of nerves. 

An overgrowth of the supporting connective tissue and 
neuroglia, with thickening of blood-vessel walls and atrophic, 
fatty or other degenerative changes in myelin sheaths and 
axis cylinders. 

Mention pathologic conditions that may give rise to 
vertigo. 

Cerebral anemia or congestion, gastritis, errors of refrac- 
tion, Meniere's disease, cerebral or cerebellar tumor, menin- 
gitis, uremia and other toxemias, epilepsy, hysteria. 

Describe the protective agencies by Avhich the body 
guards itself against the entrance and harmful effects of 
pathogenic bacteria. 

Phagocytosis, the ingestion and possible destruction of 
bacteria by certain leukocytes. Antitoxines, substances 
formed in the body that are antidotal to bacterial toxins. 
Bacteriolysins, substances resulting from the union of two 
bodies known as complement and addiment that produce the 
solution of bacteria. Antiseptic substances present in the 
blood serum and tissues that restrain bacterial growth. 

What is immunity? How is immunity produced? 

Immunity expresses the degree of resistance of the living 
organism against disease. It is produced by attacks of dis- 
ease, by the introduction into the body of living or dead bac- 
teria or their products, or of antitoxins or by heredity. 

Give the pathologic changes occurring in acute phlebitis. 

Congestion of vessels of vasa vasorum and effusion in the 
walls of vein of serum and leukocytes, with formation of 
thrombus within vessel. This may terminate in absorption 



350 PATHOLOGY AND BACTERIOLOGY. 

and resolution, the permanent occlusion of the vein, or in 
suppuration. 

What conditions (nontraumatic) favor cerebral hemor- 
rhage? Mention the vessel from which cerebral hemor- 
rhage occurs most frequently. 

a. Arterio-sclerosis or aneurysm of cerebral vessels and 
their causes, cerebral tumor, infarction, whooping cough or 
convulsions, leukemia, pernicious anemia. 

b. The left lenticulo striate artery. 

Give the histologic characteristics of amyloid degenera- 
tion. 

The amyloid substance appears in the form of irregular 
homogenous, translucent, faintly granular areas of fused 
cells and intercellular substance affecting chiefly the con- 
nective tissues about the capillaries, as in the glomerules of 
kidney or spleen. The adjacent epithelial cells may show 
atrophic changes or fatty degeneration. The urinary tubules 
may contain amyloid casts. 

What are the blood changes in progressive pernicious 
anemia? 

A marked and disproportionate oligocythemia, slight leu- 
copenia, poikilocytosis, and the presence of nucleated red 
corpuscles. 

What is the spinal lesion in tabes dorsalis? Give the 
location of this lesion. 

See locomotor ataxia. 

Give the gross and the microscopic appearance of an 
epithelioma of the lip. 

A crusted papule or warty growth, with infiltrated base, 
that tends to undergo crater-like ulceration. Microscopically, 
an invasion of the subcutaneous and deeper tissues by irreg- 
ular columns composed of squamous epithelial cells that often 
contain pearly bodies is seen. 

Give the functions and the products of bacteria. 

Functions are reproduction, motion, absorption, excretion, 



PATHOLOGY AND BACTERIOLOGY. 351 

growth; fermentation, decomposition, disease production. 
They may produce as products ferments, toxins, phosphores- 
cence, pigments, acids or alkalies. 

Give the causes of edema. 

Passive hyperemia, anemia, change in vessel walls or in 
vascular innervation, reduction in extra-vascular pressure, 
lymphatic obstruction. 

What are cysts? How are cysts formed? Give the 
varieties of cysts. 

Abnormal, persistent, encapsulated collections of liquid 
formed by obstruction to outlet of glands by secretion in a 
cavity without outlet, extravasation of blood or other liquid, 
softening of tissues, tumor formation, or by the presence of a 
parasite or foreign body. Varieties are simple, compound, 
and proliferous, congenital, retention, extravasation, soften- 
ing, neoplastic and parasitic cysts. 

What varieties of degeneration may occur in lymph 
glands? 

Fatty degeneration, pigmentary infiltration, calcification, 
hyaline degeneration, amyloid degeneration. 

Mention the malignant neoplasms. 

The varieties of carcinoma, including epithelioma ; sarcoma, 
endothelioma. 

What tissues are most frequently the seat of tubercular 
formation? 

In order of frequency — lungs, lymph glands, ileum and 
larynx, joints, pleura, meninges, peritoneum, bones, spleen, 
kidneys and genito-urinary organs. 

(a) On what principle are tumors classified? (b) Men= 
tion the important classes of tumors, giving an example 
tinder each class. 

a. The varieties of normal tissue that they typify. 

b. 1. Adult connective tissue type, as fibroma. 

2. Embryonic connective tissue type, as sarcoma. 



352 PATHOLOGY AND BACTERIOLOGY. 

3. More highly specialized tissue type, as myoma, neuroma, 
lymphangeioma. 

4. Endothelial type, as endothelioma. 

5. Epithelial type, squamous, columnar or glandular, as 
squamous papilloma, columnar epithelioma, adeno-carcinoma. 

6. Tumors of mixed type, as teratoma. 

What pathologic changes may result from cerebral 
hemorrhage? 

Cerebral hematoma, softening, cyst, cicatrix, porencephalus, 
atrophy or sclerosis. Atrophy of voluntary muscles and 
cutaneous tissues, secondary descending sclerosis of motor 
paths. 

Give the process of tubercle development. 

(1) Lodgment of tubercle bacilli, (2) Proliferation of epi- 
theloid cells and an invasion of lymphoid cells in the affected 
area, (3) Fusion of epitheloid cells with formation of giant 
cells, (4) Central coagulation necrosis, (5) Fusion of adja- 
cent tubercles with caseation, producing yellow tubercle. 

What is (a) productive inflammation? (b) Suppurative 
inflammation? 

(a) One characterized by the formation of new fibro-con- 
nective tissue. 

(b) One characterized by the formation of pus. 

What pathologic changes may cause angina pectoris? 

Arterio sclerosis of first portion of aortic or of coronary 
arteries, aortic insufficiency, adherent pericardium, mitral 
insufficiency. 

What structures are principally involved in bubonic 
plague? How are these structures affected? 

Lymphatic glands— suppurative lymphadenitis; lungs — 
a form of bronchopneumonia; intestinal tract — hemorrhagic 
gastro-enteritis ; kidneys — an acute interstitial and parenchy- 
matous nephritis ; spleen — hyperplastic splenitis. 

Mention the varieties of eczema. 

Squamous, papular, vesicular, pustular, impetiginous, ec- 



PATHOLOGY AND BACTERIOLOGY. 353 

zema parasiticum, rubrum, fissum, impetiginodes, marginatum, 
papillosum, vesiculosum, pustulosum, squamosum, sclerosum r 
seborrheicum, ulcerosum. 

What pathologic conditions increase the elimination of 
urea? 

Acute fevers, inflammations, bacterial infections, in dia- 
betes, rheumatism, gout, in lithemia. 

Give the lesions of typhoid fever. 

Catarrhal entero-colitis, infiltration and hyperplasia of 
Peyer's patches, terminating in necrosis and ulceration, hem- 
orrhages, perforation or cicatrization. Mesenteric lympha- 
denitis. Splenic hyperplasia, parenchymatous hepatitis and 
nephritis. At times degeneration of cardiac or voluntary 
muscles, hypostatic congestion of lungs and ulceration of 
larynx occur. 

What pathologic changes take place in the blood plasma? 

Hypertonicity (excess of salt) ; hyperinosis (excess of 
fibrin factors) ; hypinosis — deficiency in fibrin factors; hy- 
dremia (excess of water) ; anhydremia — deficiency in water. 
Lipemia — contains fat droplets; melanemia — contains mel- 
anin; hemoglobinemia — contains dissolved hemoglobin. Ab- 
normalities in alkalinity. 

What conditions may cause dropsical effusion in the 
abdomen and in the lower extremities? 

Cirrhosis, or tumor of the liver, syphilitic hepatitis, valvu- 
lar heart disease, pulmonary disease, neoplasms, parasites or 
inflammatory exudates interfering with the portal circulation, 
tuberculous peritonitis. 

Give the causes and pathologic anatomy of lympha- 
denitis. 

Inflammation of lymphatic glands results from irritants, 
especially the pyogenic bacteria, the tubercle bacillus and the 
bacillus of plague. The glands are enlarged, hyperemic, soft, 
pulpy, and infiltrated by serum and red and white corpuscles, 
and may suppurate. 
23 



354 PATHOLOGY AND BACTERIOLOGY. 

What is calcific metamorphosis? 

The transformation of cells into a calcareous or mineral 
substance. 

Name some of the causes of active hyperemia and give 
illustrations. 

Paralysis of vaso-constrictor or stimulation of vaso-dilator 
nerves, mechanic, thermic or chemic irritation, as shown in 
blushing, after friction of skin, application of heat or cold ? 
or action of bacterial or drug irritants. 

Illustrate and define hypostatic inflammation. 

When the circulation is insufficient the blood tends to settle 
or stagnate in dependent parts of the body (hypostatic con- 
gestion), and a form of inflammation may ensue (hypostatic 
inflammation), such as the hypostatic pneumonia occurring 
in low forms of typhoid fever. 

What are some of the phenomena attending pus for- 
mation? 

Heat, redness, swelling, tenderness, throbbing pain, soften- 
ing of tissue, fluctuation, pointing. 

Describe the pathologic conditions in hectic fever. 

Hectic fever is a persistent form characterized by high 
exacerbations at night, and resulting from microbic action, 
and, as a rule, the formation of pus within the body. 

What are the pathologic conditions causing favus? 

The proliferation in the hair follicles of a mold, achorion 
Schoenleinii. 

How are secretions affected in anemia? 

Usually decreased, although the urine may be increased 
either in bulk or relative solid contents, while the free hydro- 
chloric acid, which may be absent from the gastric secretion 
in progressive anemia, may be present in increased amount 
in chlorosis. 

Define amyloid degeneration. 

A degeneration of the tissues into a homogenous wax-like 



PATHOLOGY AND BACTERIOLOGY. 355 

substance resistent to decay, chemicals and gastric digestion, 
and giving a mahogany-brown color with dilute Lugol's solu- 
tion (amyloid reaction). 

What organs are most subject to tuberculosis? 

Lungs, lymph glands, serous membranes, bones, spleen, 
kidneys, adrenals, genital organs, bladder, skin. 

Name some of the changes which occur in extravasated 
blood. 

Coagulation, solution, replacement by granulation tissue, 
decomposition and suppuration, desiccation and scabbing. 

What glands are most frequently affected by amyloid 
degeneration? 

Liver, spleen, kidneys ,lymph glands. 

To what diseases does calcareous degeneration of the 
arteries predispose? 

Aneurysm, hemiplegia, cerebral softening, dry gangrene. 
How does sarcoma differ histologically from cancer? 

Sarcoma is an atypical hyperplasia of connective tissues 
only, and contains imperfectly formed blood-vessels. Carci- 
noma consists of masses of invading epithelial cells filling 
acini, usually formed of connective tissues in which well- 
developed blood-vessels are present. 

Give the varieties of tubercle. 

Reticulated tubercle, lymphoid tubercle, epitheloid tubercle, 
miliary tubercle, submiliary tubercle, gray tubercle, yellow 
or crude tubercle of Laennec. 

(a) What are bacteria? (b) What conditions are favor= 
able to their increase, and (c) what is meant by their toxic 
products? 

(a) Fission fungi or schizomycetes. (b) Warmth, moist- 
ure, albuminous media, usually best if of neutral or slightly 
alkaline reaction, absence of strong actinic rays, (c) Poison- 
ous substances, toxins, ptomaines or bacterial proteids formed 
by or in bacteria. 



356 PATHOLOGY AND BACTERIOLOGY. 

Name some of the principal bacteria of the staphylo=» 
cocci and the streptococci groups. 

Staphylococcus aureus, staphylococcus albus, staphylococ- 
cus citreus, streptococcus pyogenes, streptococcus erysipe- 
latis. 

Name the important pathogenic diplococci. 

Diplococcus gonorrheaica, diplococcus pneumonie, diplo- 
coccus meningiditis capsulatus of Weichselbaum. 

What changes take place in cyanotic atrophy of the 
liver? Give the microscopic appearance of this diseased 
condition 

A persistent passive congestion, with secondary hyper- 
plasia of the connective tissue and pigmentation of hepatic 
cells; microscope shows wide dilatation of capillaries and 
veins, with atrophy and pigmentation of hepatic cells and 
overgrowth of perilobular connective tissue. 

Define and illustrate bacilli, micrococci, spirilla. 

(a) Bacilli are rod shaped; micrococcci, spherical shaped; 
spirilla, spiral shaped bacteria, (b) Bacillus tuberculosis, 
streptococcus pyogenes, spirillum cholerae. 

Give the pathologic features of angioleucitis (Iymphan= 
gitis). 

The lymph vessels are inflamed, red, swollen and dis- 
tended by a cell-laden liquid. Their walls are edematous, 
infiltrated by leukocytes, and may be broken down if the pro- 
cess be suppurative. The cause is almost invariably micro- 
organismal, and there is usually an associated lymphadenitis. 

Mention the structural changes that occur in tubercular 
joints. 

Tubercles in the synovial membrane, subsynovial tissue or 
cancellous bone. Diffuse (tumor albus) or nodular (synovitis 
tuberosa) thickening of synovial membrane, or distension of 
joint with inflammatory serum (hydrops) or puriform liquid 
(empyema); erosion of cartilage and bone; tuberculous ab- 
scess and sinus formation. 



PATHOLOGY AND BACTERIOLOGY. 357 

Give the possible causes of occlusion of the bile=duct. 

Catarrhal swelling of mucous lining, lodgment of calculus 
or parasitic worm (as ascaris lumbricoides or distoma hepa- 
tinum), invasion by coccidia, cicatricial contraction of walls 
of duct, pressure from without by an adjacent tumor or 
floating kidney, involvement in a neighboring carcinoma, sar- 
coma, endothelioma or an inflammatory process, duodenal 
disease involving the terminal papilla. 

(a) What causes contribute to obesity? (b) What tis- 
sues are most frequently invaded in obesity? 

(a) Anemia, hemorrhages, use of malt liquors, lack of exer- 
cise, hereditary tendency, over-eating, certain dyspepsias. 

(b) The subcutaneous tissues and subserous tissues of abdo- 
men, especially about kidneys, in great omentum and appen- 
dices epiploica. 

In what order are the organs of the thorax and abdomen 
best examined at a post=mortem section? 

Authorities differ. The following is useful: Inspection of 
abdominal cavity, inspection of pleura, pericardium, heart and 
vessels, examination of heart, lungs, organs of neck, spleen, 
gastro-intestinal tract, liver, pancreas, genito-urinary organs, 
abdominal aorta and sympathetic ganglia. 

What is the special cause of the croupous inflammation 
found in diphtheria? 

The toxin of the diphtheria bacillus. 

Describe the comma bacillus and give the manner of its 
introduction into the system. 

A spirillum, a short, curved rod .8 to 2 microns in length, 
motile, flagellate, readily staining but decolorizing by Gram's 
methods, usually enters through the alimentary canal with 
contaminated water, milk or solid food. 

What conditions give to the system immunity from the 
harmful action of bacteria? 

The bacteriolysins, the antitoxins, the phagocytes, the anti- 



358 PATHOLOGY AND BACTERIOLOGY. 

septic action of tissue cells and juices, the protecting layers 
of epithelium. 

(a) Give the microscopic appearance of a melano=sar= 
coma and (b) state its usual sites of development. 

(a) Consists usually of vascularized tissue consisting of 
spindle cells, or at times of round cells, that have vesicular 
nuclei, and many of which contain dark pigment granules. 
(b) Skin and choroid. 

Describe the pathologic conditions in meningitis. 

An inflammation of the membranes of brain or cord char- 
acterized by congestion of meningeal vessels, edema of arach- 
noid, effusion of serum, serum and fibrin, or pus into the 
cavity of arachnoid, at times petechial or larger hemorrhages 
within or without arachnoid. Adjacent degeneration of ner- 
vous substance may occur. 

Give the pathology of cirrhosis of the liver. 

A marked hyperplasia of the interlobular connective tissue, 
and often of interlobular bile ducts. The new-formed con- 
nective tissue tends to contract, compressing the lobules and 
perhaps causing degeneration of the hepatic cells. The liver 
may become much smaller and show a rough ("hob nail") 
surface. 

(a) How is fibrous tissue formed? (b) What tumors 
are composed largely of fibrous tissue, and in what part of 
the body do they usually occur? 

(a) By a proliferation of cells of the pre-existing, adjacent 
fibrous tissue. The young cells or fibroblasts being nourished 
by new capillary blood-vessels that sprout from neighboring 
pre-existing vessels and invade the formative area. 

(b) Fibromas and fibromyomas chiefly occur in the uterus. 

What is the significance of tube=casts in the urine? 

Tube-casts result from irritative and degenerative changes 
in the epithelium of kidney, permitting an exudation of coag- 
ulable substance into the tubules, and signify renal irritation 



PATHOLOGY AND BACTERIOLOGY. 359 

or disease. They are minute cylindric bodies having a homo- 
genic matrix, in which there may be imbedded cellular or 
granular particles. 

Describe yellow or crude tubercle. 

A yellowish, rounded, firm, adherent body, one to several 
millimeters in diameter, showing under microscope a central 
caseous area, an intermediate zone of epitheloid cells and 
often giant cells, and a peripheral zone of lymphocytes. 

Give the structural differences between sarcoma and 
carcinoma. 

Sarcoma consists of connective tissue of embryonic type 
containing imperfectly formed blood-vessel?. Tissue may 
consist of round, oval, spindle or, in part, of giant cells. 

Carcinoma is less circumscribed, consists of alveoli filled by 
cuboidal, columnar or squamous epithelial cells in a stroma, 
usually of fibro connective tissue, that contains well-formed 
blood-vessels and lymphatics. 

Define anemia, hyperemia, leukemia. 

Anemia is deficiency in the quantity or quality of circulat- 
ing blood. 

Hyperemia is an excessive quantity of circulating blood in 
a part. 

Leukemia is a grave primary anemia characterized by enor- 
mous leucocytosis and pathologic changes in the spleen, red 
marrow or lymphatics. 

State the difference between degeneration and infiltra= 
tion. Illustrate. 

Cell degeneration is a condition in which the cell contents 
become abnormal. If abnormal from the deposit of substance 
from without it is termed cell infiltration, as in fatty infiltra- 
tion. If abnormal from transformation of cell contents it is 
termed a cell metamorphosis, as in fatty metamorphosis. 
Fatty infiltration and fatty metamorphosis are both examples 
of cell degeneration. 

Give the morbid anatomy of chronic bronchitis. 

Mucous membrane may be red and thickened and covered 



360 PATHOLOGY AND BACTERIOLOGY. 

by thick mucous; or pale, thinned, and showing adherent, in- 
spissated mucous masses. The thickening is due to leuco- 
cytic infiltration and overgrowth of fibrous tissue; the thin- 
ning to atrophy of the mucous membrane. The ciliated cells 
may be replaced by columnar or polygonal epithelium. 

What is thrombosis? Describe the manner of its for- 
mation. 

Thrombosis is the intravascular coagulation of blood during 
life resulting from the arrest of circulation and the formation 
of fibrin by the action of fibrin ferment upon the fibrinogen. 

a. What is mucoid degeneration? b. What is colloid 
degeneration? 

a. A conversion of cells and intercellular substance into 
mucin. 

b. A conversion of cells in colloid material, a substance 
resembling mucin but not giving its reaction. 

State the results of stenosis of the tricuspid valves of 
the heart. 

Dilatation of right auricle, cyanosis of face, passive hy- 
peremia of pulmonary and abdominal organs, anasarca. 

a. Define fatty metamorphosis, b. Give its termina= 
tions. 

a. Conversion of cells into fat. 

b. Destruction of cells, colliquation or caseous necrosis. 

What are the possible lesions in the (a) second and (b) 
third stages of syphilis? 

(a) Mucous patches, macular, papular, squamous or ulcer- 
ative syphilide, iritis, lymphadenitis, alopecia. 

(b) Gummata, syphilitic rupia, sclerotic changes in organs, 
especially the arteries, liver, kidneys and spinal cord. 

Describe the local appearances in a case of embolism of 
the middle meningeal artery. 

The affected vessel contains thrombus extending from the 
seat of embolism back as far as the first collateral branch. 
The distal branches may be shrunken, anemic, and associated 



PATHOLOGY AND BACTERIOLOGY. 361 

with cerebral softening or distended, and in the midst of a 
hemorrhagic effusion (hemorrhagic infarction). 
What is productive inflammation? 

Inflammation characterized by the formation of new tissue, 
usually of the fibro-connective tissue type. 

What changes take place in hypertrophy of the heart? 

An increase in thickness of the muscular walls of the heart, 
chiefly affecting the ventricle, blunting the apex. The cavi- 
ties may or may not be increased in size. 

Give the origin and appearance of papillomata. 

Originate from overgrowth of the papillary body, and are 
wart-like, villous, dendritic or polypoid outgrowths from skin 
or mucous membrane covered by epithelium. 

Briefly describe the types of gangrene, and give the 
conditions determining each. 

Dry gangrene or putrefactive death of a part with mini uni- 
fication is characterized by a dry, shriveled, blackish, leathery, 
friable area, and is caused by arterial obstruction, such as 
occurs in old age (senile gangrene), from arterio-sclerosis, in 
Raynaud's disease, from ergot poisoning and frost bite. 

Moist gangrene is characterized by swollen, greenish or 
blackish, cool, moist, soft, fetid area, with bleb covered sur- 
face, loosened epidermis and crepitation on palpation, and is 
due to severe infection (pulmonary gangrene, malignant pha- 
gedena, hospital gangrene), trauma, venous obstruction, dia- 
betes (diabetic gangrene), and deficient trophic innervation 
(decubitus). 

Describe the histological elements of carcinoma. 

Acini containing epithelial cells. The amount of protoplasm, 
as in other epithelial cells, is large in proportion to the size of 
the nucleus. Cells may be squamous, cylindric, cuboidal or 
polyhedral. The nuclei are usually vesicular and atypical 
karyokinetic, and other cell figures may be present. The 
stroma usually consists of well-formed fibro-connective tissue 
containing lymphatics and well-formed blood-vessels. 



362 PATHOLOGY AND BACTERIOLOGY. 

Describe tuberculosis of the skin in any of its forms. 

Lupus vulgaris is characterized by brown nodules originat- 
ing in corium, and consisting of a rather vascular granula- 
tion tissue composed of epitheloid cells, lymphoid cells, and 
frequently of giant cells. The nodules may lead to extensive 
ulceration and cicatrization. 

Describe the changes in the heart due to fatty meta- 
morphosis. 

Diffuse or circumscribed, yellowish, opaque, soft, friable 
areas of heart muscle, in the circumscribed form chiefly occur- 
ring under endocardium of papillary muscles. Microscopic- 
ally, the muscle fibres lose their striation and show fatty 
granules, usually first about the nuclei; finally fibres may 
break down into fatty particles and detritus. 

What histological changes occur in acute simple inflam- 
mation? 

Dilatation of blood-vessels, retardation and stasis of blood 
current, exudation into tissues of modified plasma, transmi- 
gration of leukocytes, and often diapedesis of erythrocytes, 
distension of lymphatics by exudate of cells and fluid, regen- 
erative or degenerative changes in the tissue cells. 

Give the pathology of carcinoma. 

Carcinoma is a malignant, uncircumscribed tumor consist- 
ing of acini, containing invaded epithelial cells in a vascular- 
ized stroma that usually consists of fib ro- connective tissue. 
The epithelial cells tend to a progressive invasion through 
the lymphatic channels. 

What is fibrinous degeneration? 

A retrogressive process in which, by the action of fibrin 
ferment upon fibrinogen, fibrin is formed. 

What do you understand by the term cirrhosis of the 
liver? 

Overgrowth in the liver of connective tissue that contracts,, 
rendering the organ smaller and firmer. 



PATHOLOGY AND BACTERIOLOGY. 363 

Is cerebrospinal fever more generally sporadic or 
endemic? 

Cerebro-spinal fever generally occurs in the form of small 
sporadic epidemics. 

Give some of the lesions in chronic diffused or inter= 
stitial nephritis. 

Microscopic. Small, granular-surfaced kidney with adhe- 
rent capsule and thinned cortex. 

Microscopic. Thickening of Bowman's capsules, hyaline 
degeneration of glomerules, increase of intertubular tissue, 
dilatation of certain tubules. 

What anatomic changes take place in the skin in chronic 
eczema? 

Enlargement of papilke, dilatation of blood and lymph 
vessels, perivascular cellular infiltration, hyperplasia of con- 
nective tissue and epithelium, atrophy of sebaceous and sweat 
glands. 

Give the varieties, the histology, and the physical char= 
acteristics of Iipomata. 

a. Diffuse and circumscribed, sessile or pediculated. 

b. Resembles normal adipose tissue, consisting of fat dis- 
tended cells supported in a light fibro-connective tissue frame- 
work. 

c. Greasy, lobulated, yellowish, encapsulated, soft growths. 
The overlying skin "dimples" when elevated. 

What part of the cord is involved in locomotor ataxia? 
Give the pathology of locomotor ataxia. 

a. Posterior columns. 

b. In columns of Goll and Burdach areas of degeneration 
showing destroyed myelin sheaths and axis cylinders and a 
proliferation of neuralgia occur. 

What are the intestinal changes in chronic enteritis? 

The mucous membrane and muscular wall may show hyper- 
plastic thickenings or atrophy. Enlargement of lymph fol- 



364 PATHOLOGY AND BACTERIOLOGY. 

licles is frequent, and polypoid masses may project from 
mucous membrane. Ulcers may be present. 

Define myomata, neuromata, angiomata. 

a. Myomata is a tumor of the type of muscle. 

b. Neuromata is a tumor of the type of nerve tissue. 

c. Angiomata is a tumor of blood or lymph vessels. 

Explain the development of pus corpuscles. 

Migrating leukocytes pass through the walls of the adja- 
cent capillaries, and in large numbers invade the area of sup- 
puration, and whether living or dead as soon as they are sur- 
rounded by liquor puris are termed pus corpuscles. 

Give the pathology of spina bifida. 

The spinal lamina being congenitally imperfect, the con- 
tents of the spinal canal tend to protrude in the form of a 
tumor. The mass usually contains fluid, and is covered by 
the attenuated cord, nerves, or by the membranes alone. 
Spina bifida occulta is a form in which the vertebral cleft is 
unassociated with the formation of a tumor. 

What are the pathologic conditions in gonorrheal op- 
thalmia? 

A purulent conjunctivitis with marked chemosis, edema of 
eyelids, profuse purulent discharge, and as complications, 
ulcerative or suppurative keratitis, with or without resulting 
perforation, anterior synechia, leucoma, staphyloma, iritis, 
hypopyon. 

What are the pathologic appearances of anemia of the 
brain? 

The blood-vessels are empty or imperfectly distended by 
blood, and if the process has been long continued the brain 
may show atrophy or degenerative changes in the involved 
areas. 

What is thrombosis? 

Intravascular coagulation of blood during life. 



PATHOLOGY AND BACTERIOLOGY. 365 

What is embolism? 

Intravascular obstruction from the lodgment of a foreign 
body. 

What is an infarct? 

The area of degenerative and inflammatory changes pro- 
duced by the lodgment of an embolus in an end artery. 

Describe the pathologic conditions present in atheroma. 

A diffuse or circumscribed mesarteritis occurs with involve- 
ment of vasa-vasorum and the production of new sclerotic 
tissue that undergoes coagulation necrosis and fatty desrer or- 
ation. This softened degenerative material is termed athero- 
matous. It may become calcified, be discharged with the 
formation of an atheromatous ulcer or cause a weakening of 
the wall, favoring rupture or aneurysm formation. 

What structural changes take place in chronic gout? 

Polyarthritis, with deposits of urate of sodium in articular 
cartilages, and about joints with formation of concretions 
(tophi). Arterio-sclerosis, hypertrophy of left ventricle and 
sclerotic changes in liver and kidneys are common, and there 
is a tendency to inflammation of the larger serous sacs. 

What are the four cardinal indications of inflammation? 

Heat, swelling, redness and pain, to which may be added 
altered function. 

Define ascites. 

An abnormal collection of serous fluid in the peritoneal 
cavity. 

What condition of the blood is generally prominent in 
all forms of rheumatism? 

Anemia with leucocytosis. Hyperinosis. 

What condition of the blood is generally prominent in 
all forms of gout? 

Excess of sodium urate. 



366 PATHOLOGY AND BACTERIOLOGY. 

Give some of the causes (pathologic) of paresis. 

A chronic, progressive meningoencephalitis characterized 
by a productive arteritis involving especially the adventitia, 
with degenerative atrophy and sclerosis of cortex and sub- 
cortical portions of brain. Degenerative changes in spinal 
cord are associated. 

What is the pathology of aneurysm? 

A localized enlargement of an artery containing blood or 
clot, due to a circumscribed stretching of one or all the coats of 
a vessel. It occurs in vessels weakened by trauma, arterio- 
sclerosis, mycotic inflammation, or by ulceration, or proximal 
to areas of thrombosis or embolism. The vessel walls forming 
the aneurysm are thinned, often calcined, with impaired elas- 
ticity, and usually having a thicker or thinner lining of adhe- 
rent, laminated fibrin. 

Describe the pathological conditions in icterus. 

The skin, conjunctivae, urine, blood and the various organs 
are tinged a yellow color by the biliary pigment. The feces 
are usually clay colored. The pulse is slow, there is a ten- 
dency to hemorrhage. 

Define the term malignant as applied to new formations. 

New growths having an inherent tendency to a fatal issue. 
Give the pathology of peritonitis. 

The peritoneum is red from vascular injection, the surface 
is dull, and may be covered by adherent fibrinous or puriform 
exudate. The cavity of the peritoneum contains serum, in 
which there may be fibrin or pus. There is a tendency for 
adjacent peritoneal surfaces to adhere, localizing the process. 

What is understood by the phrase " new formation?" 

A multiplication of certain cells of the body producing a 
mass of tissue that has no place in the normal organism, such, 
for example, as a tumor. 



PATHOLOGY AND BACTERIOLOGY. 367 

By examining the fluid removed by lumbar puncture, 
how may we distinguish between tubercular and other 
forms of meningitis? 

In tuberculous meningitis the fluid contains chiefly lympho- 
cytes, and by staining, or inoculation into animals, the pres- 
ence of the tubercle bacillus may be demonstrated. In other 
forms of meningitis the cerebro-spinal fluid, as a rule, is more 
turbid, contains chiefly polymorpho-nuclear leukocytes, and 
the causal organisms, as the pneumococcus, the diplococcus 
intracellularis meningitis or other bacterium, but not the 
tubercle bacillus. 

Differentiate a tuberculous joint from one enlarged by 
chronic rheumatism. 

Tuberculous joint disease occurs chiefly in children, affects 
usually but a single joint, has insidious onset, with slight and 
often characteristically reflected pain, and muscular rigidity ; 
is persistent, and tends to< cause flexion and pale, doughy 
thickening of joint, with later the formation of cold abscess 
and sinuses. Rheumatism usually involves several joints, 
has acute onset, is transient, with marked localized tender- 
ness, and if severe, redness and swelling. 

What part of the spinal cord is involved in progressive 
muscular atrophy? 

The anterior horns of the gray matter. 

a. What features render a tumor malignant? b. Men- 
tion some of the growths considered malignant. 

a. Invasion of adjacent tissue, recidivity, metastasis, the 
production of cachexia. 

b. Carcinoma, sarcoma, endothelioma. 

What is hardaceous (amyloid, waxy, bacony) degener= 
ation? 

The transformation of tissue into a homogeneous, wax-like 
albuminous material, giving a mahogany-brown color with 
■dilute Lugol's solution. 



368 PATHOLOGY AND BACTERIOLOGY. 

What is the pathology of plastic inflammation? 

A modified serum, leukocytes and at times erythrocytes 
escape from the vessels. The fibrin factors in this exudate 
unite, producing fibrin that may cause adhesion between con- 
tiguous viscera. Later this plastic exudate may break down, 
or, if it be replaced by new fibro-connective tissue, more or less 
permanent adhesions may result. 

What are some of the results of lymphorrhagia? 

Chylous extravasation, lymph fistulae, chyluria, chylothorax, 
chylous ascites, malnutrition, death. 

What conditions may result from enlargement of lymph 
spaces or lymph vessels? 

Capillary, cavernous or cystic lymphangioma, cystic hy- 
groma ("hydrocele of the neck"), macroglossia (of tongue), 
macrocheilia (of lip), elephantiasis, lymph scrotum. 

What inflammatory conditions may result in enlarge* 
ment of the lymphatic glands? 

Infection by pyogenic bacteria,' plague, syphilis, tubercu- 
losis. 

What noninflammatory condition may produce enlarge= 
ment of lymph gland? 

Hodgkin's disease (pseudo leukemia), leukemia (especially 
lymphatic types), lymphadenoma, secondary tumors (carci- 
noma, sarcoma) in lymph glands. 

Give the pathologic features of mechanical hyperemia 
of the liver (nutmeg liver). 

A chronic, passive hyperemic condition resulting from val- 
vular heart disease, emphysema, pleuritic exudations, aneu- 
rysm, or other obstructions to venous return. The liver is 
more or less enlarged and is deeply mottled, this being due to 
the distension of the capillaries near the center of the lobules 
by blood, often with atrophy of the adjacent hepatic cells, 
while the liver cells at the periphery of the lobules may show 
fatty or other degenerative changes. 



CHEMISTRY. 



State the conditions favorable to crystallization. 

That the molecules should be free to move, as they are when 
the substance is in fluid condition. Then melt the substance, 
or dissolve the substance; when through cooling, or evapora- 
tion of solvent, we obtain the body in crystal form. The 
substance crystallizes through the action of three great fosses, 
mechanical, chemical and magnetic. 

What temperature Fahrenheit is equivalent to a tem= 
perature of 28 degrees centigrade? What temperature 
centigrade is equivalent to a temperature of 120 degrees 
Fahrenheit? 

28 degrees C. X ! = 50.4 plus 32 equals 82.4 Fahr. Ans. 
120 degrees Fahrenheit minus 32 equals 88 X f equals 
48.8 C. Ans. 

Define atom, molecule, element, compound, chemistry. 

The atom is the smallest indivisible particle of simple matter 
that passes from one molecule to another in chemical inter- 
changes. Not capable of existing alone. 

A molecule is the smallest subdivision of matter capable of 
existing alone and retaining its characteristic properties; it 
is composed of atoms. 

An element is simple matter; the molecules forming it are 
composed of the same kinds of atoms. 

A compound is a substance, the molecules forming which are 
composed of the same kind of atoms. 

Chemistry is the science that treats of the ultimate mole- 
cules and atoms of matter, and of the laws that govern the 

(369) 
24 



370 CHEMISTRY. 

changes that molecules and atoms undergo in decomposition 
of existing substances and formation of new substances. 

Give the names of two elements or radicals in each of 
the following groups: 

Univalent. Bivalent. Trivalent. Quadrivalent. 

Hydrogen, Oxygen, Boron, Carbon, 

Chlorin. Sulphate S() 4 . Aurum. Platinum. 

Illustrate the comparative significance of the following 
affixes: ous, ic, ite, ate. 

An oxy-acid of stable compositon, or of great importance 
to arts and industries, takes the termination ic, as H 2 S0 4 sul- 
phuric acid. 

If an oxy-acid of the same elements contains less oxygen in 
its molecule it terminates in ous, as H 2 S0 3 sulphurous acid. 

Salts formed by replacing the hydrogen in part or wholly 
of an ic acid by a metal have their names terminating in ate, 
as ZnS0 4 zinc sulphate. 

Salts in which the hydrogen of an ous acid is replaced by 
a metal have their names ending in ite, as Na 2 So 3 sodium 
sulphite. 

Compare ozone with oxygen as to (a) occurrence, (b) 
properties. 

(a) Ozone is only found in air under exceptional circum- 
stances, or in limited localities, and in very minute quantities. 

Oxygen occurs in all atmospheric air in the proportion of 
about 23 per cent, by weight. 

(b) Ozone is a very energetic oxidizing agent acting like 
nascent oxygen, and oxidizing substances that resist the action 
of ordinary oxygen, as silver. 

Ozone will not support respiration, acting as an irritant to 
respiratory membranes. 

Ozone supports combustion more vigorously than oxygen. 

State the characteristics of the following mineral 
waters: Chalybeate waters, bitter waters, sulfur waters, 
effervescent waters, cathartic waters. 

A chalybeate water is a mineral water containing dissolved 



CHEMISTRY. 371 

salts of iron, usually basic carbonates. It has a slight tonic 
action, but may occasion intestinal and stomach derangement 
from its irritant action. 

Bitter waters may owe their bitter properties to Epsom 
or Glauber 's salts, held in solution, when they exert a laxative 
action ■ or a natural water may be bitter from its contact with 
vegetable substances, acquiring thereby tonic and stomachic 
properties. 

Sulfur waters are those usually containing dissolved alka- 
line sulphides, or poly-sulphides, or H 2 S, although the name 
sulfuretted waters is of more frequent use in such cases. 
Such waters exert an alterative and often slight laxative 
effect, and have a certain use in treating diseases of the skin. 
The greater value of sulfur waters is found in their use for 
bathing, in chronic cutaneous affections, in gout, in rheuma- 
tism. 

Effervescent waters are such as are strongly charged with 
C0 2 gas. It is the escape of this gas that produces the effer- 
vescence. Such waters are useful as sedative and slightly 
stimulating beverages, as the use of plain soda water in allay- 
ing vomiting. 

Cathartic waters are such as contain cathartic or laxative 
salts in solution, as Epsom spring water, containing MgS0 4 ; 
Glauber's spring water, with Na 2 S0 4 ; Carlsbad waters, Hun- 
yadi water, Saratoga waters in general. 

Their effect is not only a cathartic or laxative one, but fre- 
quently they assist elimination from other channels, as kid- 
neys, skin, etc. 

What is the antidote for nitric acid poisoning? 

Oxid of magnesium, commonly called calcined magnesia. 
Alkaline carbonates, soap, albumen, oils. 

Describe the preparation of iodid of potassium. Give 
the reaction. 

Saturate a strong solution of caustic potash in water with 
iodine. Evaporate to dryness, when a mixture of iodid and 
iodate of potassium is formed. Heat strongly, when the 



372 CHEMISTRY. 

iodate of potassium parts with its oxygen ; dissolve the result- 
ant mass in water, when from it will crystallize, on evapora- 
tion, cubes of potassium iodid. 

6KHO + 3I 2 = 5KI + KI0 3 + 3H 2 ; 

Then KI0 3 + heat = KI + 3 . 

Describe lithium as to (a) occurrence, (b) salts com= 
monly used in medicine, (c) chemistry of its use in so= 
called rheumatic affections. 

(a) Lithium occurs principally in the mineral silicates or 
phosphates, (b) Salts used in medicine : 

Bromid of lithium LiBr Carbonate of lithium Li 2 C0 3 

Benzoate of lithium LiC 7 H 5 2 Citrate of lithium Li 3 C 6 H 5 7 

Salicylate of lithium LiC 7 H 5 3 

(c) It is stated that 25 parts of carbonate of lithium will 
dissolve one thousand parts uric acid at 100.4° Fahr., so it is 
administered in gout to diminish deposits of uric acid, and to 
dissolve uric acid calculi. 

Mention the important physical, physiologic and chem= 
ical properties of ptomains. 

Ptomains are putrefactive or cadaveric alkaloids, are pro- 
duced during putrid decomposition of animal and vegetable 
matters. They are the result of the growth of bacteria that 
produce decomposition of dead animal and vegetable tissues. 
They resemble vegetable alkaloids in many important fea- 
tures ; thus some contain no oxygen and are like volatile alka- 
loids; others contain oxygen and resemble fixed alkaloids. 
They often give tests identical with those of the alkaloids; 
thus there is a ptomain that will give same color tests as 
strychnin ; another ptomain that resembles in action and tests 
atropin, etc. Ptomains may be poisonous, when they are 
called toxins ; or they may be non-poisonous. Ptomains, act- 
ing like bases, form salts. 

In their poisonous action, after a period of incubation of 
from two to six hours, symptoms of severe gastro-intestinal 
irritation occur, and then other symptoms follow, dependent 
upon the particular ptomain. 



CHEMISTRY. 373 

What are the chemical constituents of normal urine? 
Give a test for the recognition of albumin in urine. 

Chlorides of calcium, magnesium, sodium, potassium. 
Phosphates of calcium, magnesium, sodium, potassium, ammo- 
nium. Sulphates of sodium, potassium. Coloring matters, 
including urobilin, indican. Urea, uric acid (as urates), 
creatinin, creatin, hippuric acid. 

Boil the urine ; if it becomes hazy, or a coagulum forms, add 
a few drops of nitric acid, when, if the urine does not become 
perfectly transparent, albumen is present. 

State the general properties and mention the component 
elements of proteids. 

Proteids are colloidal food substances, coagulable by heat, 
alcohol and acids. They occur in both animals and plants. 
They represent high food values; among them we find albu- 
men, as of eggs, meat, flour, etc. They are composed of 
hydrogen, oxygen, carbon and nitrogen, and may also contain 
sulfur or phosphorus, and may also contain a few other ele- 
ments, as iron. 

State the principle underlying the use of antitoxins for 
the prevention or cure of disease. 

Antitoxins are found in the blood serum of animals that 
have recovered from an infectious disease, and when this 
serum is injected into other animals, or man, it renders, on 
its absorption, the animal immune from that disease. 

How may water be decomposed? Illustrate. 

By passing a current of galvanic electricity through water, 
when the hydrogen gas collects in bubbles at the negative 
electrode and the oxygen gas at the positive electrode; or by 
passing steam or vaporous water through an iron pipe heated 
to redness, when the hydrogen gas issues at the distal end of 
the pipe and oxygen is retained in chemical union with the 
iron, coating the pipe with Fe 3 4 . 

Define and give examples of the three varieties of 
attraction. 

Attraction of gravitation is the force tending to draw 



374 CHEMISTRY. 

masses of all kinds of matter together, as the attractive force 
exerted between sun and earth. 

Heterogeneous attraction or adhesion refers to surface 
attraction of unlike substances for each other; thus water 
adheres to wood. 

Homogeneous attraction or cohesion is the force uniting 
like substances, and operates in the interior of the mass as 
well as at the surface ; thus cohesion aggregates the minute 
molecules of water into visible drops. 

How many grams are there in a hectogram? How 
many scruples are contained in one pound? 

One hundred grams equal one hectogram. 

Two hundred and eighty-eight (288) scruples one pound 
(1) troy. 

What is the test for the presence of silver, of mercury, 
of lead? 

In solution : 

Silver yields a white precipitate with hydrochloric acid or 
soluble chlorides. This precipitate is silver chloride, and it 
dissolves in ammonium hydrate or hyposulphite of sodium. 

Mercury as mercurosum, in solution, gives a white precipi- 
tate with the same reagents, of mercurous chloride, not dis- 
solving, but turned black on addition of ammonium hydrate. 

Mercury as mercuricum, gives a red precipitate with solu- 
tion of potassium iodid, soluble in excess of either potassium 
iodid or mercuric solutions. 

Lead, in solution, gives a white precipitate with hydro- 
chloric acid or soluble chlorides. This precipitate is plumbic 
chloride, and is neither dissolved nor changed in color by 
ammonium hydrate, but dissolves readily in boiling water. 

How much water vapor will be formed by the union of 
500 cubic centimeters of hydrogen and 250 cubic centi= 
meters of oxygen? 

Five hundred cubic centimeters, at standard temperature 
and pressure. 

What is a graphic formula? Give five illustrations. 

A graphic formula endeavors to show the manner in which 



CHEMISTRY. 375 

the atoms are joined or arranged within the molecule by a 
diagramatic representation. 

H O 

I / 

Acetic acid. H— (J— C— O— H 

I 
H 

H— O— H Water. H— S— H Hydrogen sulfid 

H 



N 



-H | 

— H Ammonia, H C H Marsh gas. 

-H | 

H 



Give the atomic weight, atomic volume, molecular 
weight, molecular volume, and density of oxygen. 

Sixteen, atomic weight; 1, atomic volume; 32, molecular 
weight; 2, molecular volume; 1.1056, specific gravity com- 
pared with air; 15.9, specific gravity, or density, compared 
with hydrogen. 

Describe the preparation of sulfur and name the oxids 
of sulfur. 

Soil in volcanic regions saturated by sulfur is called sul- 
fur earth. This is heaped on masonry platforms and set 
on fire, when burning sulfur causes unburned sulfur to melt, 
trickling down through the mass, flowing along the masonry 
platform into tubs placed to receive it; on cooling the solid 
resulting is called crude sulfur, and is purified by subliming 
and allowing the vapor to enter a brick-lined chamber, in 
which it condenses in small round particles, technically called 
flowers of sulfur. 

As the heat in the chamber becomes high, sulfur vapor 
liquefies, and is then ladled into moulds, forming, on harden- 
ing, the roll brimstone of commerce. 
Sulfur di-oxid, S0 2 , gas. 
Sulfur tri-oxid, S0 3 , white crystals. 
Sulfur sesqui-oxid, S 2 3 , green solid. 
Sulfur per-oxid, S 2 T . 
What is Marsh's test? Describe the apparatus em- 
ployed, and give the conduct of the experiment. 
Test for detection of arsenic. 



376 CHEMISTRY. 

May use a glass flask stoppered, and through the stopper pass : 

1. A safety funnel, the lower end reaching to bottom of 
flask. 

2. An outlet tube of glass; the end passing through the 
stopper is flush with bottom of stopper, and issuing from the 
stopper it is bent at a right angle. To its far end is to be 
fitted (a) a tube bent at a right angle, lower part dipping 
into a solution of AgN0 3 . (b) A tube bent at a right angle 
so placed that the far part of tube, drawn out to a jet point, 
shall point upwards. 

Test : Place chemically pure zinc in flask, cover with dilute 
sulphuric acid, C. P.. in such quantity as will come above 
lower end of safety funnel. 

Hydrogen gas is evolved. 

Allow gas to pass from outlet tube, to which attach tube 
(a), the lower end of which is immersed in nitrate of silver 
solution. 

Heat the outlet tube at a point between flask and silver 
solution. 

At expiration of half hour should there be no brown or 
gray-black stain found on outlet tube where heated, or no 
precipitate (black) found in silver solution, and should no 
yellow precipitate form when to a little of silver solution is 
added ammonium hydrate, the zinc and acid used are free 
from arsenic. 

Then pour into safety funnel the solution suspected to 
contain arsenic, when, should arsenic be present, a black stain 
forms on outlet tube, a black precipitate appears in silver 
solution, and this solution yields yellow precipitate of arse- 
nite of silver when to it we add ammonium hydrate. 

Now remove end piece that has been used, replacing it with 
tube (b) ; apply light, when a Avhitish flame appears; if much 
arsenic a garlic odor or white halo surrounds flame. 

Hold cold white surface, as piece of porcelain, in flame ; as 
it issues from jet, when brown or black stain of metallic char- 
acter readily dissolving in solution of chlorinated lime or 
chlorinated soda, indicates positively presence of arsenic. 



CHEMISTRY. 377 

What is olefiant gas? Name some of its properties. 

Olefiant gas, or ethylene, C 2 H 4 , heavy carburetted hydrogen. 

A colorless gas, feeble ethereal odor, density 14 compared 
with hydrogen. 

Can be liquefied, and is then used to produce low temper- 
ature on its evaporation. Is inflammable, burning in air with 
brilliant flame. It is largely to the presence of this gas that 
illuminating gas yields light. 

Mixed with three volumes of oxygen and lit, it explodes. 
One volume of olefiant gas with two volumes of chlorine burn 
with red flame. 

What is meant by the destructive distillation of wood, 
and what are some of the principal products of such a 
process? 

Heating wood in a retort until it entirely loses its charac- 
teristics as wood, and collecting and cooling resultant vapors. 

Methyl alcohol, pyroligneous acid, creosote, carbolic acid, 
etc. 

Name and differentiate the three classes of sugars. 

Glucose, C 6 H 12 6 , crystallizes in white rounded masses. 
Its solutions polarize light to the right. Its crystals contain 
one molecule of water. It reduces metallic solutions, as of 
gold, silver, copper. 

Fructose or levulose, C 6 H 12 6 , occurs in fruits, crystallizes 
without presence of water, rotates light to the left, is directly 
fermentable. 

Saccharose, C^H^On, cane sugar, obtained principally 
from sugar-cane, crystallizes in hard oblique rhombic prisms 
without water of crystallization, rotates light to left, dissolves 
in one-third its weight of water, does not reduce alkaline 
copper solution. 

What is acetous fermentation? 

An advanced stage of the alcoholic fermentation. Brought 
about by presence of the mycodermic aceti, and it causes the 
souring of alcoholic liquors. It practically consists in the 
oxidation of alcohol, producing acetic acid. 

C 9 H 5 0H + 2 = C 2 H 4 2 + H 2 0. 



378 CHEMISTRY. 

How are chlorides chemically recognized in urinalysis? 

By their yielding a white precipitate of chloride of silver 
on the addition of a solution of silver nitrate to the urine. 

Complete the following equations and write the name 
of each resulting compound under its formula: 

CJICLO + NaHO = 

C 2 HCl 3 0+NaHO=CHCl 3 +NaCH0 2 

Chloroform -f- sodic formate. 

Pb(N0 3 ) a + K 2 Cr0 4 = 

Pb(N0 3 )\+K 2 Cr0 4 =PbCr0 4 +2KN0 8 

Plumbic chromate + potassic nitrate. 

Describe two experiments showing the difference be=» 
tween chemical and mechanical action. 

Mix 32 grains sulfur and 56 grains iron filings; a magnet 
will remove all of the iron, or bi-sulphid of carbon will dis- 
solve all of the sulfur. This mixing of sulfur and iron is a 
mechanical act, in which iron and sulfur still preserve their 
properties. Apply heat to such a mixture; a temperature 
much higher than the degree of heat applied will appear, due 
to chemical union of sulfur and iron, and a magnet will no 
longer attract iron, nor will bi-sulphid of carbon have solvent 
action. This is a chemical action resulting in formation of 
a new substance, iron sulphid, in which properties of iron 
and sulfur no longer exist. 

Dissolve sugar in water. No heat is evolved; each drop of 
water shows characteristic sweetness of sugar ; has been no 
chemical change, but a physical or mechanical one. Dissolve 
sugar in sulfuric acid, obtain black liquid containing no char- 
acteristic sweetness; sugar has entirely disappeared. This 
experiment is an illustration of chemical action. 

Prove the indestructibility of matter. 

Dissolve 10 grains pure silver in nitric acid; evaporate this 
liquid to dryness. A white residue left is nitrate of silver, 
and will weigh 15.7 grains. 

Silver has totally disappeared as metal, changing its 
form to a white crystalline body called nitrate of silver, but 



CHEMISTRY. 379 

that the silver is not destroyed can be proven by heating the 
nitrate of silver on charcoal, adding to it sodium carbonate; 
as a result we will obtain 10 grains of the metal silver used in 
our original experiment. 

If potassium be thrown on water, what is the name and 
formula of the resulting compound? 

Potassium hydroxid, KOH, obtained when the water is 
evaporated to dryness. 

What are the general methods by which crystals may 
be obtained? 

Solidification by evaporation from solution. 
Solidification after fusion. 
Solidification by sublimation. 
Solidification by electrolysis upon a solution. 

Discuss arsenic and mention its properties, uses and 
compounds. 

Arsenic, As 2 3 , is the trioxid of element arsenicum. 

Arsenicum is found combined in many ores, particularly 
those of metals, zinc, iron, nickel. 

The arsenious anhydrid, As 2 3 , is generally obtained by 
sweeping the flues of smelting works, treating ores of the 
metals mentioned. By subliming this impure arsenious anhy- 
drid we obtain the pure product. 

In the ore the element arsenicum occurs generally as a sul- 
phid (orpiment or realgar). 

Heat oxidizes it to the oxid As 2 3 , commonly called white 
arsenic. 

This substance has slightly sweetish taste, metallic then 
nauseating. It is both corrosive and poisonous. Antidote 
is freshly prepared, hydrated, sesquioxid of iron with mag- 
nesia : 

Add MgO or aqua ammonia to ferric sulphate or ferric 
chlorid solutions, and collect and wash the resulting brown 
precipitate. 

Arsenic is but slightly soluble in water, soluble in most 



380 CHEMISTRY. 

acids. It sublimes unchanged, or if a reducing agent be used, 
it yields on heating the brownish-black element arsenicum. 

Arsenic is used in shot making, 40 pounds to a ton of lead. 

Enters into formation of other metallic alloys. 

Used medicinally as an alterative tonic, in doses not exceed- 
ing 1-20 of a grain. 

Used in treating malarial cachexia. Has been used as 
caustic in certain cancer cures. 

Has large use in dentistry as a devitalizing agent. 

Useful in chronic forms of certain skin diseases. 

Preparations are arsenious acid, which is chemically the 
arsenious anhydrid. Tri-chlorid of arsenic, AsCl 3 . Bromides 
of arsenic and gold, and chlorids and iodids of these metals 
and of mercury. Fowler's solution, containing arsenite of 
potassium. 

What is an anesthetic? Give the formula and proper= 
ties of any one anesthetic with which you are familiar. 

A substance used to produce partial or complete uncon- 
sciousness, and thus allay pain of operative procedures and 
produce muscular relaxation. 

It may be local in its effects, when consciousness is pre- 
served, but the part subjected to its action loses all' feeling. 
May be general in effect, when consciousness and muscular 
power is lost. 

Ether, (C 2 H 5 ) 2 0. This anesthetic, i-f used to its full 
effect, will produce entire unconsciousness and complete mus- 
cular relaxation. It produces death by (generally) causing 
centric paralysis of respiration. 

State the chemical properties of phosphorus. 

Is electro-negative, is triad and pentad in valency. Has 
great affinity for oxygen, burning in air or in oxygen gas, to 
produce phosphorus or phosphoric anhydrid respectively. 

It undergoes spontaneous combustion in air, when finally 
divided, or if in contact with iodine, bromine, and some other 
substances. 

It yields two important oxids, P 2 3 and P 2 5 , and several 
others of but little importance. 



CHEMISTRY. 381 

It enters into the formation of the various phosphoric acids, 
of phosphorus acid, and their corresponding salts. 

How much water would be required to yield ioo grams 
of hydrogen? 

Nine hundred grams of vapor of water would yield 100 
grams hydrogen and 800 grams oxygen. 

Compare the physical properties of chlorin, bromin, 
iodin and fluorin. 

Chlorin, a heavy green gas ; bromin, a heavy dark red liquid ; 
iodin, scale-like blue-black solid ; fluorin, a light yellow gas. 

All dissolve in water in varying degrees. Bromin yields 
orange-colored vapor ; iodin, violet vapor. 

Define evaporation, distillation, filtration, annealing, 
hard waters. 

Evaporation is passing of a liquid into a vapor from the 
surface of the liquid. This process takes place at all tem- 
peratures. 

Distillation is performed by applying heat to a liquid in 
a closed vessel, provided with an outlet tube, through which 
the resulting vapor is conducted and cooled, and again con- 
denses to the liquid state. 

Filtration is the act of passing a liquid through a material 
provided with very minute spaces or holes that allow the 
liquid to pass, retaining the solid suspended matters. 

Annealing consists of heating a metal or other substance 
(glass), and then allowing it to slowly cool, thus softening it 
or removing hardness (temper). 

Hard waters are those containing an excessive amount of 
dissolved mineral salts. 

Name the constituents of the atmosphere. Give the 
composition by weight and by volume. 

"Weight. Volume. 

Oxygen 23 20.93 

Nitrogen.... 77 79.07 

Including about one per cent, of argon. 



382 CHEMISTRY. 

Water vapor, .5 to 1. 
Carbon dioxid, .04. 
Traces of ammonia and nitric acid. 

Several rare gases, lately separated, of which but little is 
known. 

Name bodily conditions effecting an increase in the elim=» 
ination of urine and also those producing a decrease. 

In health urine is increased in amount where from any 
cause the perspiratory function or alvine discharges are less- 
ened, as from chill of the surface, cold bathing, etc. 

The ingestion of much fluid, as drink or watery foods. 

In health urine is decreased from a reversal of above con- 
ditions. 

In disease urine is increased in diabetes mellitus, in chronic 
inflammation of kidneys, etc. 

Often at crisis of a severe disease, in hysteria and in other 
nervous disorders. 

In disease urine is decreased when disease is accompanied 
by high fever, in acute inflammation of kidneys, in severe 
infectious diseases. 

Name three common kinds of spirituous liquors and de=» 
scribe their manufacture. 

Whiskey, from grain ; brandy, from grape juice ; rum, from 
molasses. 

In each instance fermentation is first brought about, when 
the results of such fermentation are distilled at certain fixed 
temperatures. 

Give the chemistry of photography. 

A dry plate of glass is covered with an emulsion of silver 
bromid in gelatine. 

When exposed to light the parts upon which the light 
strikes have their silver bromid changed to a lower salt. 

The plate is then subjected to the action of a developer, as 
solution of pyro-gallic acid, when the lower salt of silver bro- 
mid is reduced to metal silver, which is left upon the plate. 
The plate is then washed in hyposulphite of sodium solution, 



CHEMISTRY. 383 

when all of the unchanged silver bromid is dissolved and 
removed, but the metal silver is not affected and still remains 
upon the plate; this forms a negative. From this negative, 
placed upon a paper prepared in much the same manner as 
the plate, the action of the sun prints the finished photograph. 

Complete the following equations and write the name 
of each resulting compound under its formula: 

Ca(HO) 2 + C0 2 = CaC0 3 + H 2 

Calcium carbonate -f- water. 

NaC 2 H 3 2 + NaHO = CH 4 + Na 2 C0 3 

Marsh gas -f- sodium carbonate. 
What is meant by atomic weight? 

The atomic weight of an element refers to the ratio by 
weight which its atom bears to the atom of hydrogen. 

The atomic weight of an element is that number which 
multiplied by its specific heat yields a product of 6.4, nearly. 

Explain the difference between a solid and a liquid. 

In a solid the attraction of aggregations binds the mole- 
cules so closely together that they have no readiness of move- 
ment, so that the substance preserves a fixed form. 

A solid does not unite after the passage of a cutting imple- 
ment. 

A liquid has its molecules less tightly bound together, so that 
they may flow readily. A liquid has no fixed form, save that 
of the containing vessel. A liquid reunites after its separa- 
tion by a cutting implement. 

What is a gas? 

An air-like body difficult to liquefy. The molecules making 
up a gas are self-repellent, each molecule striving to pass as 
far from its neighbors as possible. 

What is water chemically considered? 

Water is the monoxid of hydrogen. Its composition by 
weight, 18 pounds of water contains 2 pounds of hydrogen 
and 16 pounds of oxygen. By volume two quarts of water 
vapor contain two quarts of hydrogen and one quart of oxy- 



384 CHEMISTRY. 

gen condensed on chemical union to measure but two quarts 
in all. Water may act as an electro-positive or basic body, 
as in its union with S0 3 , to form H 2 S0 4 . 

Water may act as an electro-negative or acidulous body, as 
in its union with K 2 0, to form 2KHO. 

Water generally acts as a neutral substance. Water ex- 
ists in three states, solid, liquid and gaseous. It is the great- 
est of solvents, and gives form and often color to crystals. 

How would you determine the specific gravity of a 
liquid? 

Use a hydrometer: An instrument of glass, cylindrical in 
shape, weighted below, and terminating above in an upright 
stem of glass, upon which are engraved lines indicating 
degrees. 

Place this instrument into the liquid to be examined, and 
note to which mark or degree the instrument sinks. 

This degree denotes the specific gravity of the liquid com- 
pared with water. 

Of what are the common forms of urinary calculi com= 
posed? 

Uric acid, oxalate of calcium, phosphate of calcium, phos- 
phate of magnesium and calcium, urate of sodium and potas- 
sium. 

What is organic chemistry? 

The chemistry of the hydrocarbons and their derivatives, 
also including cyanogen and its compounds in the study. 

What is the purpose of litmus paper in urinalysis? 

For determining if the urine be acid, alkaline or neutral 
in reaction, also whether the acidity be marked or slight, and 
whether the alkalinity be of fixed or volatile character. 

Describe a test for sugar in urine. 

Render the urine alkaline by the addition of sodium hy- 
drate solution, then add subnitrate of bismuth and boil. If 
the subnitrate of bismuth loses its white color, becoming 
brown or black, it indicates the presence of glucose. 



CHEMISTRY. 385* 

Free sulfur, or some sulfur compounds, like albumen, will 
have a similar effect, so to determine if the bismuth salt be 
darkened by sulfur : 

Render urine alkaline, as before, and add litharge and boil. 
If litharge does not blacken, it was not sulfur that caused the 
change of the bismuth salt, but was glucose. 

How is excess of uric acid shown in the urine? 

By a ring of whitish color forming above the point of con- 
tact in the urine when nitrate acid has been poured below the 
urine in a test-tube ; such ring disappears when gently heated. 

What effect is produced in mixing air with a blast flame 
as practiced with an ordinary b!ow=pipe? 

The air so dilutes the gas as to bring every particle of the 
gas in complete contact with the oxygen of the air, thus occa- 
sioning perfect and complete combustion of the gas. The air 
also directs the flame to a desired point. 

What metallic element is constantly present in the 
coloring matter of the blood? 

Iron. 

What is an alcohol? 

An alcohol is a hydrate of an alcohol radical. 

An alcohol is a water in which one of the atoms of hydrogen 
in each water molecule has been replaced by an alcohol 
radical. 

Explain the process of combustion. 

Combustion is chemical union taking place between two or 
more substances, accompanied by the evolution of heat and 
light. 

Name the lightest of all known elements. 

Hydrogen. 

Etherion has been obtained recently from atmospheric air, 
and is estimated to be one ten-thousandth the weight of 
hydrogen. 
25 



386 CHEMISTRY. 

What is chemical affinity, and give an example? 

Chemical affinity expresses the desire for chemical union 
which substances show to certain other substances; thus it is 
this attractive power of chemical affinity that causes the 
union of chlorin with hydrogen. 

Give the symbols of antimony, silver, gold, iron and 
zinc. 

Antimony, Sb; silver, Ag; gold, Au; iron, Fe; zinc, Zn. 

How would you prepare hydrogen? 

Place zinc in a flask provided with a safety funnel, the 
lower end of which reaches to the bottom of the flask. 
Through a second opening in the stopper of the flask have an 
exit tube provided, the lower end of which enters the flask to 
but a short distance. Then pour into the flask through the 
funnel dilute sulfuric acid. Hydrogen gas is formed, and 
escapes through the exit tube. 

Give the formula and name of the most common salt of 
sodium. 

Sodium chlorid, NaCl. 

What acid contains chlorin as an important element? 

Hydrochloric acid, HC1 (muriatic acid). 

What do you understand by the humidity of the atmos- 
phere? 

Humidity of the atmosphere refers to the quantity of vapor 
of water present in atmosphere (total humidity) or to the 
ratio of vapor of water present in the atmosphere compared 
to the quantity of water vapor the atmosphere at that tem- 
perature could hold (relative humidity). 

How does wine differ chemically from brandy? 

Wine contains from 8 per cent, to 18 per cent, of alcohol; 
brandy from 45 per cent, to 55 per cent. Wine is a product 
of fermentation of fruit juices; brandy results from distilling 
the fermented product of fruit juices. Wine contains a num- 
ber of compound volatile ethers that are not present in brandy. 



CHEMISTRY. 387 

What is the substance (or substances) from which ordi- 
nary alcohol is derived? 

Grain, as oats, rye, corn, all of which first undergo germi- 
nation, then fermentation, then distillation, when the extra- 
neous matters may be separated by chemical means or by 
fractional distillation. 

What element constitutes four=fifths of the air? 

Nitrogen. 

Explain the principle of the Bunsen burner. 

The Bunsen burner is supplied near its base with aper- 
tures for the ready admission of air and its mixture with gas 
before the latter is lit. Each particle of gas is thus supplied 
with sufficient air to obtain perfect combustion. 

What is the essential element of all acids? 

Hydrogen. 

Name three substances usually classed as sugars. 

Glucose, levulose, saccharose. 

Name three elements in the potassium group. 

Potassium, sodium, lithium. 

Is sulphurous acid a solid, a liquid or a gas at ordinary 
temperature? 

It is a liquid resulting when S0 2 is dissolved in water. 
What is albumen? 

It is a proteid body composed of H, C, 0, N, and S ; it is 
colloidal, and is changed in digestion into crystalizable pep- 
tone. It occurs in vegetable structures as well as in animal. 

Name the principal sources of bromin. 

Natural mineral waters containing magnesium bromid in 
solution. Sea waters. 

Give the name and formula of a compound of sulfur and 
hydrogen. 

Hydrogen sulM, H 2 S (sulfuretted hydrogen). 



388 CHEMISTRY. 

What is the meaning of the sesqui in chemical nomen= 
clature? 

It means one and a half, and refers to one and a half times 
the volume of one element in combination with one volume of 
a second element, or it refers to one and a half times the 
atomic weight of one element in combination with once the 
atomic weight of another element; but inasmuch as we can 
have no half atoms in formulas, it is customary to preserve the 
ratio between the weights of the elements while using whole 
numbers. Example: Fe 2 3 , sesqui-oxid of iron. 

Where does potassium occur? 

Potassium always occurs combined with other elements in 
nature existing in organic salts in plants, and when such 
plants are burned the organic salts decomposing yield, in the 
ash of the plant, carbonate of potassium. 

Give the formula explaining the preparation of chlorin, 
in equation form. 

Mn0 2 + 4HCI = MnCl 2 + 2H 2 + Cl 2 

Define and give an example of each of the following: 
(a) Binary compound, (b) acid, (c) hydrate, (d) salt. 

(a) A compound containing two elementary forms, as 
AgCl. (b) An acid is a salt of hydrogen having a sour taste, 
bleaches vegetable colors, turns litmus red, corrosive action, 
when concentrated, upon tissues, unites with and neutralizes 
bases, forming salts and water, as HN0 3 . (c) A hydrate is a 
member of the water type, in which one hydrogen atom in a 
molecule of water has been replaced by a metal or an electro- 
positive radical, as KOH. (d) A salt is a substance formed 
by the replacement of all or part of the hydrogen of an acid 
by a metal, as K 2 S0 4 . 

What are the laws governing combination of elements? 

1. All chemical compounds are definite in their nature; 
the ratio of the elements forming them is constant. 

2. If one element unites with another in more than one 
proportion such proportions will be multiples or submultiples 
of each other. 



CHEMISTRY. 389 

3. The proportion by weight in which any two elements 
will unite with a third element represents that proportion in 
which they would unite with each other if they could so 
combine. 

What is a chemical reagent? 

A substance having an active chemical effect upon other 
chemical substances. A substance which by its contact with 
another substance creates new compounds that can be appre- 
ciated by us, and thus afford a test for detecting the body to 
which the reagent has been added. 

Mention a pentad element and explain the name. 

Nitrogen. 

A pentad element is one the atom of which desires five 
monad atoms to fully satisfy the pentad atom in its desire for 
chemical union. 

Explain the terms (a) amorphous, (b) alkali, (c) water 
of crystallization, (d) amalgam, (e) nascent state. 

(a) Amorphous means powdery, non-crystalline solid, (b) 
Alkali a body possessing the strongest of basic or electro- 
positive properties, usually referring to oxids and hydrates 
of alkaline metals or metals of the alkaline earths, (c) Water 
of crystallization is water present in solid structures pre- 
serving their geometrical form and frequently the color of 
the crystal bodies; it may be removed by heating at temper- 
atures not higher than the boiling point of water, (d) An 
amalgam is a solution or mixture of a metal and mercury, 
(e) Nascent state, or newly born, refers to matter in its atomic 
form, or before the individual atoms freed from a compound 
have united to form molecules. 

What are the properties and uses of glucose? 

A white or yellowish-white, sweetish substance, freely solu- 
ble in water, possessing not quite the sweetening power of 
cane sugar. It is obtained from starch and starch-like sub- 
stances, as cellulose. Its formula is C 6 H 12 O e , and it can now 
be obtained in crystal form. It polarizes light towards the 
right. It converts blue cupric hydrate into red cuprous oxid 



390 CHEMISTRY. 

when heated with solutions of the copper salt. It is used 
as a substitute for cane sugar. 

What is the difference between nitric oxid (NO) and 
air? 

Nitric oxid is a colorless gas, becoming orange-red the in- 
stant it comes in contact with air or oxygen; it can be lique- 
fied, giving rise to a blue colored liquid. It will not support 
combustion nor respiration. It has a fixed and definite per- 
centage composition, and is a chemical compound. Air is not 
a chemical compound, but a mechanical mixture of one part 
oxygen to four parts nitrogen. Air is colorless, not changing 
in contact with oxygen. When liquefied is without color. It 
supports combustion and animal respiration. We may sepa- 
rate the oxygen and nitrogen in air with but little difficulty, 
but cannot so readily separate oxygen and nitrogen in nitric 
oxid. 

Give equation for the production of ammonia from 
ammonium chlorid and calcium hydroxid. 

2NH 4 C1 + Ca2HO = 2NH 3 + 2H 2 + CaCl 2 . 

How was salicylic acid originally derived? How is it 
now manufactured? What are its properties? 

It was originally obtained from oil of gaultheria. It is now 
manufactured by passing C0 2 into a heated retort containing 
sodium carbolate. 

C 6 H 5 ONa + C0 2 = C 6 H 4 ( OH) CO.ONa. 
and decomposing this sodium salt with HC1. 

It occurs in fine white needle-shaped crystals, permanent in 
air, of sweetish taste, acid reaction, soluble in 450 parts of cold 
water, soluble in 2 parts alcohol; solution produces intense 
violet color with ferric salts. 

Used as food preservative, is antiseptic and anti-rheumatic. 

Describe the method of preparing H by the action of Na 
on H 2 0. Write the formula for the reaction and find how 
many grams of H 82 grams of Na would make by this pro- 
cess. (The atomic weight of H is 1, of O 16, of Na 23.) 

Place a piece of clean-scraped sodium in a combustion 



CHEMISTRY. 391 

spoon and cover it with a cage of gauze wire to hold it in 
place. Fill a cylindrical glass jar completely full of water 
and invert mouth down in the pneumatic trough. 

Plunge combustion spoon containing Na quickly under 
water, below the mouth of the glass jar; the Na at once decom- 
poses water, and bubbles of hydrogen gas rise in the jar. 

Na + H 2 = NaOH + H 

23 + 18 = 40 + 1 

23 grams of Na = l gram H 

23:l::82:X = 3.565 + of H. 

Give a brief description of three experiments illustrating 
the properties of oxygen. 

Plunge a smouldering piece of charcoal in a jar of oxygen 
and the charcoal kindles, burning brilliantly. 

Heat a watch spring at one end until red-hot, then plunge 
into jar of oxygen, and the steel spring burns with great 
brilliancy, to change to ferric oxid. 

Place a piece of phosphorus in a test-tube, cover it with 
water, warm slightly. Now if a jet of oxygen be directed by 
a long glass tube upon the phosphorus, the latter will catch 
fire, burning below the surface of the water. 

What is the source of phenacetin? 

It is a product of the destructive distillation of coal tar. 
Give the occurrence in nature of phosphorus; of chlorin. 

Phosphorus occurs in nature as phosphate of calcium in 
the mineral apatite, and as phosphate of calcium and as phos- 
phate of magnesium in bones. It is also found as phosphin 
from rotting phosphoretted bodies. Chlorin occurs in nature 
chemically combined with metals, as NaCl, AgCl, etc. As 
NaCl it is found in sea water, river water, and in most nat- 
ural waters, and also in mineral deposits, as rock salt, and in 
the tissues and fluids of animal bodies, and in plants. 

What are the chemical names of (a) borax, (b) plaster 
of Paris, (c) marble, (d) blue vitriol, (e) saltpeter? 

(a) Sodium bi-borate, or sodium pyro-borate. (b) Anhy- 



392 CHEMISTRY. 

drous calcium sulphate, (c) Calcium carbonate, (d) Copper 
sulphate, (e) Potassium nitrate. 

Define positive element, negative element. Illustrate 
each. 

A positive element is one which, on the decomposition of a 
compound by electrolysis, will be found deposited upon the 
negative electrode. 

A negative element is one which, for its chemical combina- 
tions, selects an electro-positive or metal element. A negative 
element will be deposited at the positive electrode when a 
compound containing it undergoes decomposition by elec- 
trolysis. 

Iron, gold and hydrogen are positive elements. Oxygen, 
sulfur and chlorin are negative elements. 

Mention the halogens and state in what respects they 
exhibit marked similarity. 

Chlorin, bromin, iodin, fluorin, cyanogen. 

All are monads, all electro-negatives, all form simple or 
hydrogen acids. First four possess bleaching and disinfect- 
ant action. All combine with metals. Except nuorin, they 
form oxy-acids and oxy-salts. 

Mention the properties of hydrogen. 

Hydrogen is a colorless, odorless, tasteless gas. The light- 
est of the well known elements. Practically insoluble in 
water, burns with a colorless flame, yielding more heat in its 
burning than an equal weight of any other substance. In its 
combustion in air it forms water. Mixtures of hydrogen 
with oxygen or air explode when heated. 

Hydrogen is not poisonous, but will not support combustion 
nor respiration. It is electro-positive. When liquefied it 
forms a steel-blue liquid that is opaque to the passage of light. 
It is used as a standard for many scientific determinations, 
as, for instance, of valencies, of classification of elements and 
radicals, of specific gravities of gases and vapors. 



CHEMISTRY. 393 

State (a) the normal specific gravity of urine, (b) the 
causes of abnormal deviations in the specific gravity of 
urine. 

From 1018 to 1025. Specific gravity is lowered in poly- 
uria, as of diabetes insipidus. In chronic interstitial neph- 
ritis. In certain nervous disorders, as hysteria, chorea, etc. 

Specific gravity is above 1025 in diabetes raellitus, in acute 
inflammation of kidney, in certain crises in course of chronic 
nephritis accompanied by partial suppression of urine. 

In certain disorders of digestion. 

In febrile affections. 

Give the chemical reaction of (a) saliva, (b) gastric 
juice, (c) urine. 

(a) Faintly alkaline, (b) Acid, (c) Acid. 

Mention the principal chemical constituents of bile. 

COMPOSITION OF BILE. 

Water 91.68 Soaps 1.39 

Mucus and pigment .129 Fat .73 

Glycocholate of sodium 3.03 Lecithin .53 

Taurocholate of sodium .87 Cholesterine- -. 35 

State the properties of aluminum and mention its im= 
portant salts. 

It is the lightest of metals used for building purposes, etc. 
It has a specific gravity 2.5. It does not oxidize in air, and 
•does not tarnish. It is strong, possesses considerable malle- 
ability. Its salts of greatest use are ammonium and potas- 
sium alums. 

Give the properties of two important salts of zinc used 
medicinally. 

Zinc sulphate, ZnS0 4 , used as an astringent, in watery 
solution, for local application, as in form of sprays, injec- 
tions, gargles, eye-washes. Internally, in doses of half 
drachm, is used as a mechanical emetic, being free from 
depressant effect. Sulpho-carbolate of zinc, in doses of from 
2 to 10 grains. Used as an intestinal antiseptic, as in typhoid 
fever ; also used in solution as an antiseptic wash. 



394 CHEMISTRY. 

Give in detail two tests for ascertaining the presence of 
albumen in the urine. 

Raise the specific gravity of the urine 10 degrees by adding 
sufficient saturated solution of sodium chlorid in water; then 
add a few drops of acetic acid to this mixture, and holding 
the test-tube at the bottom allow the upper layer of fluid to 
be heated to boiling in the flame of a Bunsen burner. If any 
coagulation or diminished degree of transparency occurs in 
the heated portion of the fluid, compared with the unheated 
portion, albumen is present. 

Place a 10 per cent, solution of ferrocyanide of potassium 
in a test-tube and add to it half its volume of acetic acid ; mix 
well. Then run down the side of the tube the suspected urine 
so that it floats upon the reagent without mixing. If albu- 
men is present there will be impairment in transparency of 
the liquids, or even an evident precipitation if much albumen 
be present. 

Give the formula and properties of methane and describe 
its preparation. 

Methane, CH 4 , is a colorless, tasteless gas. It is the light- 
est of compound gases. Its specific gravity is but half that of 
air. It is called marsh gas and light carburetted hydrogen. 
It burns readily when lit in air. It is the first of the series 
of paraffins, or saturated hydrocarbons. It is also called gas 
of the acetates, from its method of production. To obtain it 
heat four parts of sodium acetate, four parts of sodium hy- 
droxid, and six parts of lime. The true reaction takes place 
between the two sodium compounds. 

NaC 2 H 3 2 + NaOH = CH 4 + Na 2 C0 3 . 

What are compound ethers? Give an example. 

Compound ethers are those in which different alcohol radi- 
cals replace the two hydrogen atoms of the molecule of water. 

Thus: 

H OH 

C,H 5 O C 3 H 7 ; 

or C 5 H 12 Ethyl-propyl ether. 



CHEMISTRY. 395 

What is glycerin? How is it chemically classified? 

Glycerin is a bland, heavy, oily-like liquid of a charac- 
teristic sweetish taste ; a marked attraction for water and great 
solvent powers, particularly for oils, and for many drug 
substances. 

Glycerin is a tri-atomic alcohol, or it consists of the organic 
radical C 3 H 5 in chemical union with three OH ions, as 
C 3 H 5 30H or C 3 H 8 3 . 

State the preparation, appearance, formula and uses of 
acetic acid. 

Acetic acid may be obtained by destructive distillation of 
wood; the product called pyroligneous acid is subjected to 
certain processes, at the end of which a salt of an acetate, 
generally calcium acetate, results, and from this acetate 
acetic acid is obtained by process of chemical substitution. 
Formula is HC 2 H 3 2 . 

It is a colorless liquid of strong, sour, pungent odor. Has 
sour and corrosive taste and action. In concentrated form 
it crystallizes at about 60 degrees F. ; in dilute form it consti- 
tutes vinegar. It is used for softening and removing callous 
tissues; used as a disinfectant; useful in preparations of 
Basham's mixture. 

What chemical changes take place in the body after 
death? 

The fats undergo decomposition; oxidation of various tis- 
sues takes place. The H and S, formerly combined in differ- 
ent tissues and in moisture, unite to form H 2 S, gas. Phos- 
phorus leaves its chemical combinations in bone and other 
tissue to combine with hydrogen, forming PH 3 . Nitrogen 
unites with hydrogen to form NH 3 . The other substances 
assume finally a dry condition after fats, oils and liquids 
have been dissipated. 

Define base, basic radical, isomerism. 

A base is the oxid or hydrate of an alkaline or alkaline 
earth metal, or it is a body of electro-positive condition, 



396 CHEMISTRY. 

which in solution neutralizes an acid to form salt and water, 
turns red litmus blue, emulsifies fats, and has a harsh acrid 
taste. 

A basic radical is an atom, or an unsaturated group of 
atoms, having an electro-positive condition and an action 
similar to that of a base. 

Isomerism refers to the fact that chemical compounds may 
be composed of the same elements in the same percentage 
proportion by weight yet be different and distinct substances 
having very different properties. 

Give the properties of chlorin. State the source and 
mention the most important of its compounds that are 
used in medicine. 

Chlorin is a heavy green, irrespirable gas, of density com- 
pared to hydrogen of 35.4, about 2% times heavier than air. 
Soluble in water, has bleaching action on organic coloring 
matter in presence of water, showing great affinity for hy- 
drogen, acting as monad electro-negative radical. Source: 
It is usually obtained by heating hydrochloric acid and 
manganese-dioxid. It exists in largest quantity combined 
with sodium, forming NaCl. Compounds used in medicine 
are: 

Sodium chlorid Mercurous chlorid 

Mercuric " Ferric chlorid 

Arsenious " Cocain muriate 

Zinc 

From what is boron obtained? Mention two important 
compounds of this element. 

From borax or from boracic acid. 

Two compounds, borax and boracic acid. 

State the normal reaction of urine. How is the reaction 
noted? To what is it due? 

Reaction acid. By use of litmus paper, which should turn 
red when wetted with urine. Acidity due to presence of acid 
phosphate of sodium, and, in a less degree,, to presence of uric 
acid (pathological). 



CHEMISTRY. 397 

Give the sources and use of carbolic acid. 

Obtained from destructive distillation of wood or of gas 
tar. Carbolic acid is used as a disinfectant and feebly-acting 
local anesthetic, and also as an escharotic. 

Define qualitative analysis, quantitative analysis. Illus= 
trate each. 

Qualitative analysis consists in breaking up a compound 
or a complex body into easily recognizable, simpler bodies. 
Thus qualitative analysis of cane sugar shows it to be com- 
posed of C, H, and 0. 

Quantitative analysis seeks to determine the quantity of 
the constituents of a compound. Thus quantitative analysis 
of 18 pounds of water shows it to be composed of 2 pounds of 
hydrogen and 16 pounds of oxygen. 

Describe the chemical process for the preparation of 
alcohol. What percentage of alcohol is found in (a) beer, 
(b) wine, (c) whiskey, (d) brandy? 

The fermented liquor from grain is subjected to fractional 
distillation. To the distillate is added oxid of calcium, and 
this mixture again distilled, yielding absolute alcohol, (a) 
Five per cent, (b) Eight to eighteen per c^nt. (c) Forty- 
five to fifty-five per cent, (d) About fifty per cent. 

Describe two tests for glucose. 

Glucose in solution, if boiled with an alkaline cupric hy- 
drate solution, reduces the copper salt to the red sub-oxid of 
copper, forming a precipitate. 

Glucose in solution placed in the polarizing saccharimeter 
bends the ray of light towards the right. 

What are peptones and how are they produced? 

Peptones contain C, H, 0, N, S, and sometimes P, and are 
dialyzable, feebly acid products, from the result of the action 
of gastric juice upon albuminous bodies. They are very solu- 
ble in water, and are insoluble in alcohol and ether. They 
are precipitated by heat or acids. They polarize to the left. 
Except mercury, the metallic salts form no precipitates when 



398 CHEMISTRt. 

their solutions receive an addition of peptone. They are 
readily assimilable. 

What are ptomains? What are leucomains? How are 
ptomains produced? 

Ptomains are putrefactive or cadaveric alkaloids, found in 
putrid decomposition of animal and vegetable substances. 

Leucomains are alkaloidal or basic substances formed in 
the body during life. 

Most of them are deleterious, and are usually eliminated 
by the kidneys. 

They generally occur during the course of disease. 

How do globulins differ from albumins? 

Globulins are insoluble in water, but soluble in one per 
cent. NaCl solution. Except vitellin, they are precipitated 
by saturated solutions of NaCl. They are soluble in very 
dilute HC1, 1 to 1000 strength, forming acid albumin. 

Complete the equation: NaC 2 H 3 2 + NaOH = 
NaC 2 H 3 2 + NaOH = CH 4 + Na 2 C0 3 . 

Explain the nomenclature of binary compounds. Which 
element is to be placed first, and how is the termination 
of the second to be altered? 

Binary compounds are those composed of two elements. 
The electro-positive or metallic element being placed first. 
The second element terminating in "id." Examples: Ag 2 S, 
argentic sulphid; NaCl, sodic chlorid. 

Define hydrate, anhydrid, latent heat, gravitation. 

A hydrate is a member of the water type of compounds, in 
which one hydrogen atom of the molecule of water is replaced 
by an electro-positive element or compound radical; should 
the electro-positive radical be diad, it would replace two 
hydrogen atoms in two molecules of water, as KOH instead 
of HOH, Ca(OH) 2 instead of 2HOH. 

An anhydrid is the name applied to acidulous oxids that 
are capable of combining chemically with water to form acids, 
as S0 3 , sulphuric anhydrid ; N 2 5 , nitric anhydrid. 



CHEMISTRY. 399 

Latent heat is heat not manifesting itself as temperature, 
but is required to retain the substance in liquid or in gaseous 
form. 

Gravitation is the force seeking to draw all substances 
together. It acts upon masses of matter, and the force of its 
action varies directly as the masses of the attracting bodies, 
and inversely as the square of the distance separating the 
bodies. 

Describe a method of producing an electric current by 
chemical action. 

Immerse two sheets, one of copper and one of zinc, in a 
vessel containing dilute sulphuric acid, and connect them out- 
side of the acid by a wire. An electric current will be at once 
produced, starting from the zinc sheet, traversing the liquid, 
being received upon the copper sheet, up which it passes to 
leave the battery cell along the conducting wire leading from 
the copper ; continuing along this wire it returns to the battery 
cell. 

Describe methods for determining atomic weights. 

1. Determine the specific gravity of the element when in 
the gaseous state compared with hydrogen. 

2. The product of the atomic weight multiplied by the spe- 
cific heat being 6.4, then divide 6.4 by the ascertained specific 
heat of the element, the quotient being the atomic weight. 

3. Note the weight of an element required to take the place 
of a given weight of hydrogen in forming a replacement or 
substitution compound. Thus acetic acid is HC 2 H 3 2 , and 
practical demonstration shows that one grain of hydrogen in 
acetic acid may be replaced by 108 grains of silver to form 
silver acetate, AgC 2 H 3 2 ; hence one equivalent of silver 
weighs 108 times that of hydrogen, or one atom of silver 
weighs 108 compared to the weight of one atom of hydrogen. 

Explain the difference between metals and non=meta!s. 

Metals are (as a rule) solid bodies of considerable weight, 
more or less malleable, ductile and tenacious. They are good 
conductors of both heat and electricity. When liquefied they 



400 CHEMISTRY. 

are opaque to the passage of light. They possess lustre, they 
are electro-positive, they are capable of forming bases, they 
can displace the hydrogen of acids to form salts. Their 
names terminate in the suffix ' ' um. ' ' 

Substances not possessing most of these characteristics are 
grouped as non-metals or metalloids. 

Explain the process of manufacturing sulphuric acid on 
a large scale. 

Sulfur or a sulfid is burned in a plentiful supply of air, 
and the resulting sulfur dioxid gas, S0 2 , is carried into a 
series of leaden-lined chambers. Along with the sulfur 
dioxid, vapor of nitric acid also enters these chambers; this 
vapor is generally produced through heating a mixture of 
sodium nitrate and sulfuric acid. Steam also is admitted 
into these chambers. The sulfur dioxid becomes oxidized to 
sulfur tri-oxid (S0 3 ) through the action of nitric acid vapor. 
This sulfur tri-oxid then combines chemically with water 
(steam) to form sulfuric acid, H 2 S0 4 . 
Reactions : 

S0 2 + 2HN0 3 = H 2 S0 4 + N 2 £ 
Then N 2 2 + air (0 2 ) = N 2 4 
Then 2S0 2 + N 2 4 = '2S0 3 + N 2 2 
Then 2S0 3 + 2H 2 = 2H 2 S0 4 . 
The result is a constant formation of dilute sulfuric acid 
falling in a rain to the floor of the leaden chamber, from there 
removed to be concentrated in glass or platinum stills. 

The last leaden chamber terminates in a tall chimney to 
provide sufficient draft to keep the gases in motion. At the 
beginning of this chimney is arranged a chamber called Gay 
Lussac's tower, in which are packed flints kept moistened 
with strong sulfuric acid. This is for the purpose of absorb- 
ing N 2 4 gas, thus preventing its loss from the chimney. 
This sulfuric acid, charged with the peroxid of nitrogen, is 
used in the first or initial leaden chamber, where spread over 
stones, or falling in cascade, the entering sulfur dioxid gas 
may come in contact with the nitric peroxid gas, thus occa- 
sioning the oxidation of the S0 2 gas. 



CHEMISTRY. 401 

State the symbol, valence, atomic weight, chemical 
properties and principal medicinal preparations of phos= 
phorus. 

Symbol, P ; valency, I., III. and V. Atomic weight, 31. 

Phosphorus is a yellow wax-like solid, heavier than water, 
occurring in several allotropic forms. It is insoluble in 
water, but soluble in carbon di-sulfid, in oils, chloroform, 
and slightly soluble in ether and in hot alcohol. It melts at 
temperatures below the boiling point of water 

It vaporizes at all temperatures, giving rise to a garlic-like 
odor. Phosphorus has a great affinity for oxygen, burning 
when heated in air or oxygen. The results of its combustion 
are: Phosphorous anhydrid (P 2 3 ) if the supply of air be 
limited, or yielding phosphoric anhydrid (P 2 5 ) if the supply 
of air be unlimited or if it be burned in oxygen. 

It combines directly with a number of substances. With 
some, as iodin and bromin, its combination is attended by 
active combustion. When finely divided it takes fire sponta- 
neously in air. Allotropic forms are red, black and white 
phosphorus; red phosphorus is less poisonous, not so readily 
combustible, and is insoluble in carbon di-sulphid. 

Medicinal preparations : A class of salts of both metals and 
alkaloids, known as the hypo-phosphites, containing the triad 
acidulous radical P0 2 . There are three phosphoric acids of 
importance : 

Ortho phosphoric acid, formula H 3 P0 4 . 

Pyro phosphoric acid, formula H 4 P 2 7 . 

Meta phosphoric acid (Glacial), formula HP0 3 . 

These acids all form salts, some of which are used in medi- 
cine. Most important, neutral sodium phosphate, Na 2 HP0 4 . 

How is hydrofluoric acid prepared and what are its uses? 

By heating powdered calcium fluorid (CaF 2 ) with sulfuric 
acid, the resulting gas, passing into water, forms a watery 
solution of hydro-fluoric acid. 

CaF 2 + H 2 S0 4 = CaS0 4 + 2HF. 

Used for etching or dissolving glass. Used for preparing 
peroxid of hydrogen. 
26 



402 CHEMISTRY. 

What is glycogen? From what is it derived? 

Glycogen (C 6 H 10 O 5 ) n resembles starch, forms opalescent 
solution in cold water ; derived from liver cells. 

What is the normal chemical reaction of (a) saliva, (b) 
gastric juice, (c) pancreatic juice, (d) blood, (e) tears? 

(a) Alkaline, (b) Acid, (c) Alkaline, (d) Acid, (e) 
Neutral. 

What are albumenoids? Mention some of the imports 
ant albumenoids. 

The class of albumenoids are substances containing carbon, 
hydrogen, oxygen, nitrogen, and generally sulfur or phos- 
phorus. They exist in animal and in vegetable structures. 
They form food substances of great value. They are colloidal, 
and are converted by digestion into crystallizable bodies called 
peptones. 

Among albumenoids we find white of egg, blood, meat, peas 
and beans. 

Give and explain (a) an empiric formula, (b) a rational 
formula. 

(a) The simplest possible expression by formula of a compo- 
sition of a compound, giving the kind of elements present and 
the proportion the number of atoms in a molecule of the body 
bear to each other, thus CH 2 is the empiric formula of 
acetic acid. 

(b) A rational formula shows the manner in which the 
different atoms or radicals combine in order to make one 
molecule of the body, thus HC 2 H 3 2 is the rational formula 
for acetic acid. 

What is the chemical antidote for poisoning from lead 
acetate? Explain the chemical action of this antidote. 

A soluble sulphate, as magnesium sulphate (Epsom salts), 
which in contact with acetate of lead forms an insoluble sul- 
phate of lead. 

Pb2C 2 H 3 2 + MgS0 4 = PbS0 4 + Mg(C 2 H 3 2 ) 2 . 



CHEMISTRY. 403 

Complete the following equations and give the names 
of the resulting compounds: 

HgS0 4 + Hg + 2NaCl = 
FeS0 4 + 2NaHC0 3 = 
HgS0 4 + Hg + 2NaCl = Hg 2 Cl 2 (or 2HgCl) + Na 2 So 4 

Calomel Sodic sulphate 

FeS0 4 + 2NaHC0 3 = FeC0 3 + H 2 + Na 2 S0 4 + C0 2 

Ferrous carbonate + water -j- Sodic dioxid 

sulphate carbon 
Mention five elementary substances commonly used in 
medicine. 

Sulfur, phosphorus, iron, iodin, oxygen. 

Define chemical action, physical action. Give examples 
of each. 

Chemical action takes place in the interior of the molecule. 
It is accompanied by the development of heat. Can only 
occur under favorable conditions. When chemical action 
occurs the identity of the bodies entering into chemical action 
is lost, and new substances are produced. Chemical action 
requires definite weights of the substances between which it 
occurs. 

Physical action takes place outside of the molecule. It is 
not necessarily accompanied by the evolution of heat. The 
substances do not lose their identity. Any quantities of the 
substances may undergo physical action. Examples: Chem- 
ical action, add HC1 to marble dust, forming a gas, carbon 
dioxid ; also forming water and chlorid of calcium. Physical 
action, adding water to sugar we do not lose the' characteristic 
properties of the water or of the sugar. 

State the chemical changes produced within a galvanic 
cell while in action. 

Cell composed of zinc and copper with dilute sulfuric acid. 
The acid dissolves zinc, forming a solution of zinc sulphate. 
The hydrogen of the acid, disengaged in bubbles, passes 
through the liquid to the opposite sheet of copper. Thus the 
strength of acid is constantly lessened through its decompo- 



404 CHEMISTRY 

sition and the formation of sulphate of zinc, until finally all 
acidity will have disappeared from the battery fluid. 

Define distillation, sublimation, destructive distillation. 
Give example of each process. 

Distillation consists in the passing of a liquid into a vapor- 
ous condition when heated to its boiling point, and the sub- 
sequent condensation of this vapor again to the liquid form 
on cooling the vapor. Example : Distillation of water. 

Sublimation is the passage of a solid into a vapor on being 
heated, and the condensation of that vapor again to the solid 
form on cooling without the substance passing through an 
intermediate liquid state. Example: Subliming iodin, thus 
obtaining it pure. Destructive distillation refers to a form 
of distillation in which the substance in the retort, when 
heated, is entirely destroyed, and from the vapors arising 
new substances are collected when these vapors condense on 
cooling ; thus through destructive distillation of wood we may 
obtain creasote. 

What are the constituents of common illuminating gas? 
How is it prepared? Why is it poisonous? 

Marsh gas, CH 4 ; olefiant gas, CH 2 ; Acetylene gas, C 2 H 2 . 

Ammonia, hydrogen sulphid, carbon monoxid, carbon di- 
oxid, hydrogen. 

It is prepared from the destructive distillation of bitumi- 
nous coal. Its poisonous effects are largely due to carbon 
monoxid present. 

Describe the preparation and appearance of flowers of 
sulfur, roll sulfur, precipitated sulfur. 

Flower sulfur, prepared by subliming sulfur and cooling 
the vapor. It is deeply yellow in color, and examined by the 
microscope shows rounded globular masses. 

Roll sulfur, of yellow color, coming in sticks about two 
feet in length and two inches in diameter. Obtained by pour- 
ing melted sulfur into wooden moulds, in which the sulfur 
hardens. 



CHEMISTRY. 405 

Precipitated sulfur, the whitest of all the sulfur prepara- 
tions, sometimes called milk of sulfur, is prepared by boiling 
sulfur in an alkaline solution until the sulfur dissolves,, when, 
on the addition of hydrochloric acid to this solution, sulfur 
precipitates in a fine almost white powder. 

State a method for preparing oxygen. What are the 
properties of oxygen which make it of use medicinally? 

Heat barium dioxid at a temperature higher than a red 
heat, when oxygen will be evolved and may be collected for 
use. Oxygen is a quickly acting, readily diffusible stimulant 
to heart and to respiration. Its use is indicated as a respi- 
ratory stimulant and a general stimulant to all functional 
activity. 

Mention the substances used for disinfection after the 
prevalence of contagious disease and explain their action. 

Sulfur burned, forming S0 2 , which acts as a disinfectant 
through its dehydrating effect upon germ life. 

Chlorinated lime in presence of acid liberates chlorin gas, 
and this latter, combining chemically with hydrogen of 
moisture, sets oxygen free; the oxygen then acts destructively 
upon disease germs. 

What percentage of C0 2 exists normally in the atmos- 
phere? What percentage C0 2 is dangerous to life? 

Atmospheric air contains .04 by volume of CO. ; . A greater 
percentage of C0 2 than .06 by volume would be dangerous 
to life if the C0 2 were accompanied by animal impurities 
from animal respiration. Ten per cent, of C0 2 in air will 
prove poisonous, although unaccompanied by animal respi- 
ratory impurities. 

State the properties of nitric acid and describe its prepa- 
ration. 

Nitric acid, aqua fortis, specific gravity 1.5, colorless liquid, 
fuming in air, highly corrosive, stains upon tissues or fabrics, 
not discharged by the use of ammonium hydrate. It turns 
litmus red, will dissolve most of the metals, parts readily with 



406 • CHEMISTRY. 

its oxygen, forming nitrous acid. It is obtained by roasting 
nitrate of sodium and sulfuric acid, and carrying the gas so 
produced into water, this forming a watery solution of nitric 
acid. 

Define and describe sugars. How do glucoses differ 
from saccharoses? What kind of sugar is found in dia= 
betic urine? 

Sugars are organic compounds called carbohydrates; all 
consist of C, H, and 0, with twice the number of H atoms in 
each molecule as of atoms. They occur in vegetable and 
animal structures. Glucoses are represented by the formula 
C c H 12 6 ; they polarize light towards the right; they reduce 
cupric hydrate to red sub-oxid of copper. They crystallize 
with difficulty; they are not of as great saccharin strength 
as cane sugar. 

Saccharoses, formula C 12 H 22 11 , polarize light to the left, 
do not reduce cupric hydrate, readily crystallize, possess max- 
imum saccharin effect. 

Glucose is found in diabetic urine. 

Give the chemical name and properties of (a) calomel, 
(b) corrosive sublimate. Mention two easily applied tests 
that will distinguish one from the other. 

Calomel, hydrargyrum mono-chlorid, or mercurous chlorid, 
Hg 2 Cl 2 or 2HgCl. Is a laxative, may by continued use cause 
constitutional poisoning; occurs as an impalpable, insoluble 
powder. When added to lime water a mixture black in color, 
called blackwash, results, (b) Corrosive sublimate is hydrar- 
gyrum bi-chlorid, or mercuric chlorid, HgCl 2 . 

It is an alterative, anti-syphilitic, antiseptic and highly 
poisonous substance. It occurs in fine crystals, and is slightly 
soluble in water, freely soluble in alcohol. When to it lime- 
water is added a white mixture results, known as whitewash. 

Give the chemical name of iodoform. How is iodoform 
made? 

Iodoform is the tri-iodid of methane, formed when three 



CHEMISTRY. 407 

iodin atoms replace three hydrogen atoms in a molecule of 
marsh gas. Its formula is CHI 3 . It is manufactured by 
boiling a solution of iodid of potassium, potassium hydrate 
and alcohol. 

Define chemistry, physical change, chemical change. 

Chemistry is the science that treats of the ultimate mole- 
cules and atoms of matter, and of the laws that govern their 
changes. A physical change is one taking place outside the 
molecule, and does not result in the loss of properties of the 
bodies engaged, and is not of necessity accompanied by heat. 

Chemical change only takes place under favorable condi- 
tions between fixed weights of substances, operates in the inte- 
rior of the molecule, is accompanied by the evolution of heat, 
the formation of new bodies, and the loss of identity of sub- 
stances undergoing change. 

State the atomic theory. 

All matter is composed of minute quantities of substances 
called molecules, and each molecule is made up of indivisible 
parts called atoms, which in their union to form molecules 
unite in fixed quantities by weight and in obedience to fixed 
laws. 

Give the properties and uses of bromin. 

Bromin is a heavy red-brown liquid, specific gravity 2.99. 
It vaporizes at all temperatures, giving rise to orange-red 
fumes. It is soluble in water, is caustic, and its vapor irre- 
spirable. It is an electro-negative liquid element. It com- 
bines with many metals to form binary salts, called bromids, 
as NaBr, KBr, AgBr. It is monad in valency. Its solution 
in water is a disinfectant, and bleaches. Its salts, the bro- 
mids, as of iron, arsenic, sodium, potassium, gold, are .useful 
in medicine. Bromin is used to make hypobromite of sodium 
for the determination of urea in urine. Bromin forms a series 
of oxy-salts and oxy-acids. 

State the valence of the following radicals: (CN), (HO), 
(N0 2 ), (CO), (HC). 

CN, monad; HO, monad; N0 2 , monad; CO, diad; HC, triad. 



408 CHEMISTRY. 

Give the names and formulas of three sodium salts. 

Sodium bromid, NaBr. 
Sodium chlorid, NaCl. 
Sodium iodid, Nal. 

How is ferric chlorid made? Give the chemical equa- 
tions. 

Dissolve iron in aqua regia, or by subjecting iron to the 
action of free chlorin gas. 

Fe 2 + 6HC1 + 2HN0 3 = Fe 2 Cl 6 + N 2 2 + 4H 2 Q. 

Give in detail a test for arsenic in a mixture of food 
taken from the stomach. 

To the stomach, contents add about one-seventh as much, 
by volume, of pure HC1, warm, and at intervals of from 10 to 
15 minutes add potassium chlorate, about a gram at a time, 
continuing the application of heat; soon most of the organic 
matter originally present will be decomposed, when a uniform 
liquid results strain through muslin. Add to this liquid 
sulfurous acid to reduce any arsenic anhydrid, formed through 
the oxidation from potassium chlorate, to arsenious anhydrid. 

Heat to drive off any excess of sulfurous acid, then through 
the resulting liquid pass hydrogen sulphid gas for several 
hours. Collect this precipitate, and to it add ammonium 
hydrate, which will dissolve a portion of the precipitate. 
Test this dissolved portion or filtrate for arsenic by Marsh's 
test. 

Define allotropism. Mention the allotropic forms of (a) 
carbon, (b) sulfur. 

Allotropism refers to substances possessing the same chem- 
ical composition, but exhibiting different properties. Carbon 
occurs as a dense black solid. Its allotropic forms are graph- 
ite and diamond. Sulfur occurs as a lemon-yellow octahedral 
crystalline solid. Its allotropic forms, electro-positive sulfur 
in needle-shaped crystals, neutral sulfur, plastic sulfur. 
Each of these forms show variations in density and solubilty, 



CHEMISTRY. 409 

and in other physical characteristics, from the usual octa- 
hedral sulfur. 

Give the average amount and the composition of normal 
urine voided by an adult in 24 hours. 

Amount 50 ounces 

Water 40 ounces 

Solids 1000 grains 

Urea - 500 " chlorids, K&Na 170 grains 

Uric acid 10 " sulphates, K&Ca 40 " 

Hippuric acid... 15 " phosphates, K&Na 45 " 

Creatinin 15 " ," Mg&(,a 30 " 

Pigment, mucus 1 , ™ 

v , . , . > 1 1 9 grains. 

Xanthine, other extractives J 

What is the formula of chloroform? State how it is 
prepared. 

Chloroform, CHC1 3 . 

Made by distilling a mixture of chlorinated lime and alco- 
hol, and subjecting the result to certain purifying processes. 

Give the chemistry of acetic acid and mention the most 
important acetates. 

Acetic acid, HC 2 H 3 2 , is obtained from fermentation 
(acetic acid fermentation) of alcoholic liquids, as cider, etc. 

It may be obtained through the action of sulfuric acid on 
alcohol. 

Important acetates include acetate of lead, of iron, of alum- 
inum, of sodium, of potassium. 

Mention five alkaloids. Give the derivation of each. 

Strychnin, from nux vomica ; morphin, from opium ; quinin, 
from cinchona bark; cocain, from erythroxylon coca; atro- 
pin, from belladonna. 

Complete the following equations: 

CH 3 I + HKS = 

CS 2 + 2H 9 + 6Cu = 

CH3I + HKS = CH 3 HS + KI 

CS 2 + 2H 2 + 6Cu = 2H.S + CO, + 6Cu. 



410 CHEMISTRY. 

State the properties of potassium. Mention ten potas= 
sium compounds of importance in medicine. 

Potassium is a soft white metal, slight bluish tint, decom- 
poses water at all temperatures, burning in contact with water. 
It is one of the strongest electro-positive elements, is of monad 
valency, is lighter than water, fuses below a red heat . 

Compounds of importance in medicine are : 

Potassium iodic! Potasstum chlorid 
" nitrate " sulphate 

carbonate ' ' bi-carbonate 

bromid " cyanide 

chlorate " hydrogen arsenide 

" and antiraonial tartrate 

Define specific gravity. Give a method of determining 
the specific gravity of a solid substance insoluble in water. 

Specific gravity refers to the ratio by weight a given volume 
of a substance bears to the weight of an equal volume of some 
substance used as a standard. 

Weigh substance in air, then suspend it in water and weigh 
while immersed, subtract weight in water from weight in air, 
divide weight in air by loss of weight shown when weighed 
in water, quotient will be specific gravity of substance. Ex- 
ample: Gold weighs 10 grains in air, in water weighs 9% 
grains, loss equals half a grain, then 10 weight in air divided 
by one-half, or the loss of weight when in water, equals 20, 
the specific gravity of gold. (True specific gravity of gold 
would be 19.3.) 

Give the chemical name, properties and uses of tartar 
emetic. 

Tartar emetic is potassium antimony bi-tartrate, or com- 
monly called bi-tartrate of potassium and antimony. For- 
mula : KSbOC 4 H 4 6 . 

It is an impalpable white soluble powder, sublimes when 
heated, is very poisonous. Used as an emetic and as a nau- 
seating and sedative expectorant. 

In what part of the body is sulfur found? 

Sulfur exists in all tissues and fluids of the body that pos- 



CHEMISTRY. 411 

sess color. Sulfur is present in the different substances of 
an albumenoid nature. 

What kind of albumen in morbus Brightii? What 
properties render it readily detectable? 

Serum albumen. 

It is readily detected through its coagulability by heat or 
acid. 

What is the chemical treatment for carbolic acid poi= 
soning? 

Antidote, a soluble sulphate, as Epsom salt (magnesium 
sulphate), and forming an insoluble sulpho-carbolate in the 
body. 

Use of oils and emollients to allay irritation. 

How is chlorinated lime made? What is the principal 
use of chlorinated lime? 

By passing chlorin gas over slaked lime, spread upon 
shelves in a properly constructed room. 

Ca2HO + Cl 2 = CaClOCl + H 2 0. 

Its chief uses are as a bleaching agent and a disinfectant. 
In both instances its action only takes place in the presence 
of moisture, when the chlorin that it disengages combines 
chemically with the hydrogen of moisture, thus freeing the 
oxygen from moisture to act as the real disinfectant or bleach- 
ing substance. Chlorinated lime liberates chlorin when in 
contact with an acid. 

What chemical change takes place when a photographic 
plate is exposed to daylight? 

The silver salt which coats the plate is decomposed at such 
points as are exposed to light. The use of pyrogallic acid 
further reduces such portions with a deposition of metallic 
silver on the plate ; the plate being washed with hyposulphite 
of sodium has all of its unaltered silver salts dissolved and 
removed, so that the plate then contains a reverse picture 
called a negative, formed by thin films of metal silver adherent 
to the glass. 



412 CHEMISTRY. 

To what class of organic compounds does glycerin be- 
long? From what source is glycerin obtained? 

Glycerin is a tri-atomic alcohol. 

It is obtained by passing super-heated steam through fats, 
thus causing a separation of glycerin from the fatty acid. 

What is the difference between an alcohol and a phenol? 
Illustrate. 

Phenols differ from alcohol in : 

1st. Not forming corresponding aldehydes and acids on 
oxidation. 

2d. In not dividing into water and hydro-carbons under 
the influence of dehydrating agents. 

3d. In not reacting with acids to form ethers. 

Phenols form more stable compounds with metal elements 
that more closely resemble salts. 

What are carbohydrates? Into what three groups are 
these compounds usually divided? 

Carbohydrates are organic compounds, composed of C, H, O, 
in which the H and exist in the relative proportions in 
which they are present in water. 

Amyloses, glucoses, saccharoses. 

Define alkaloid and give an example. 

An alkaloid is an active, nitrogenous, organic base, occur- 
ring in vegetable and animal bodies. Strychnin found in the 
beans nux vomica. 

In what principal form is nitrogen eliminated from the 
human body? 

Urea. 

Give the formula, uses and properties of hydrogen 
dioxid. 

H 2 2 . Used as a disinfectant, and a bleaching agent, and 
an oxidizing substance. Used in restoring oil paintings. 
It is usually sold in a watery solution containing from 10 






CHEMISTRY. 413 

to 12 volumes of true hydrogen dioxid, or of about 3 per cent. 
in weight. True peroxid of hydrogen is a thick, syrup-like 
liquid obtained through the evaporation of watery solutions 
of peroxid of hydrogen over strong sulfuric acid in a vacuum. 
Peroxid of hydrogen readily parts with an atom of oxygen, 
particularly if brought in contact with organic matter, and 
it is this nascent oxygen that effects the bleaching, disinfectant 
action, etc. 

Give the formula and properties of each of two oxids of 
carbon, explaining the effect of each on animal life. 

Carbon-monoxid, CO. 

This substance is a gaseous body, almost insoluble in water, 
no odor, burns with blue flame to form carbon dioxid. 

It acts as a direct poisonous agent to animals, causing de- 
composition of blood. 

Animals poisoned through the action of carbon-monoxid 
have the oxygen-carrying power of the red blood corpuscles 
destroyed. 

Carbon-monoxid is lighter than air. 

Carbon-dioxid, C0 2 , is a colorless gas, heavier than air, no 
odor, soluble in water, upon which it confers increased solvent 
powers. It is a normal constituent of air. It is not a direct 
poison when inhaled, except it be in quantities constituting 
over 10 per cent, of the inhaled air. It is, however, not cap- 
able of supporting life. 

It does not burn, nor does it support combustion. 

It enters the air from respiration of animals, and in such 
respiration poisonous materials are exhaled accompanying the 
carbon-dioxid. 

It is to these poisonous matters from animal respiration, and 
not to the presence of carbon-dioxid, that the deleterious 
effect of breathing pre-breathed air is due. 

Describe the preparation of nitrous .oxid, writing the 
reaction. State the properties and use of nitrous oxid. 

Nitrous oxid results when ammonium nitrate is heated in a 



414 CHEMISTRY. 

retort at temperatures between 460 degrees to 490 degrees 
Fahr. 

NH 4 N0 3 + heat = N 2 + 2H 2 0. 
It is a colorless gas, slightly sweetish taste, has no odor. 
It is soluble in water, heavier than air. It readily supports 
combustion, owing to its decomposition by the heat of the 
burning body introduced in it, so that it is actually the lib- 
erated oxygen that supports combustion. It does not burn. 
It is used for the production of general anesthesia of but a 
short duration. It is regarded as the safest of general anes- 
thetics, and has a large use in dentistry for operations of a 
short duration. A common name applied to it is "laughing 
gas." 

Describe phosphorus as to (a) derivation, (b) proper* 
ties, (c) commercial uses, (d) medicinal uses, (e) medN 
cinal preparations. 

(a) From apatite or from bones, each of these substaifces 
containing tri-calcium phosphate. 

(b) In its usual form is a yellow wax-like solid, occurring 
also in red, black and white allotropic forms. 

Yellow phosphorus is spontaneously inflammable in air, 
especially if it be finally divided, it has an odor of garlic, is 
highly poisonous, is insoluble in water, but dissolves in oils, 
in bi-sulphid of carbon, slightly soluble in hot alcohol, etc. 
It glows in the dark, it melts and will take fire below the boil- 
ing point of water. It can be burned under water in a jet of 
oxygen gas. Takes fire on contact with iodin, bromin. 

(c) Making matches, insecticides. Is used in certain metal 
alloys to give closer grain and prevent oxidation in the alloy, 
as in phosphor bronze. 

(d) Used medicinally in doses of l-100th of a grain as a 
nervous reconstructive drug. Has considerable use in treat- 
ing many nervous disorders. 

(e) Medicinal preparations — phosphorus, phosphoric acid 
dilute, the phosphates, as of sodium, iron, etc., the hypo- 
phosphites of metals, and of alkaloids as well. 



CHEMISTRY. 415 

Define reaction, reagent. 

When one active chemical substance is brought in contact 
with another, separation of the constituents of each substance 
occurs, and then these constituents rearrange themselves to 
form new bodies; this is the reaction that follows the initial 
chemical action. 

A reagent is a substance capable of bringing about the 
above results when added to a chemical compound. 

State properties and uses in medicine of the bromin salts. 

Bromids are used to depress functional activity of the 
spinal cord. They belong to the class of motor depressors. 
They are all soluble save silver, lead, mercury, tin and copper. 

Hypo-bromite of sodium is used as a reagent in the deter- 
mination of the quantity of urea in urine. 

Give the names and formulas of the various gaseous 
compounds capable of producing general anesthesia. 

Nitrous oxid, N 2 ; chloroform, CHC1 3 ; ether, (C 2 H 5 ) 2 0. 

A few other substances are used for the production of 
anesthesia, but they have not as general a use nor as satis- 
factory an action as those given. 

Describe a method of detecting the presence of lead 
salts in water. 

Concentrate the water to small bulk, add a few drops of 
ammonium hydrogen sulphid, when a black precipitate or 
coloration appearing may indicate the presence of lead or 
other deleterious metallic additions to the water. 

This test is usually performed upon water two feet in depth 
in a tall glass cylinder. 

How may the presence and amount of urea be deter- 
mined? 

Make a fresh solution of hypo-bromite- of sodium by dis- 
solving 100 grams of caustic soda in 250 cubic centimeters 
of water, and when cold adding 25 grams of bromin. 

Place this solution in the closed arm of a Doremus' ureo- 



416 CHEMISTRY. 

meter. Now add one cubic centimeter of urine, so that it may 
mix with the hypo-bromite solution in the closed arm of the 
apparatus. The urea present is decomposed, its components 
are absorbed with the exception of nitrogen gas, which, passing 
to the upper portion of the tube, depresses the column of 
liquid downward. The space occupied by the nitrogen gas 
then serves to indicate the quantity of urea in the one cubic 
centimeter of urine operated upon. 

Mention a chemical antidote for sulfuric acid and explain 
the action of this antidote. 

Magnesium oxid. 

It chemically combines with sulfuric acid to form sulphate 
of magnesium. This action is accompanied by the evolution 
of but little heat and no gas, and all corrosive properties of 
the acid entirely disappear in the change or neutralization 
that it undergoes. 

What is fermentation and how is it produced? What 
are enzymes? 

Fermentation is the decomposition of a non-nitrogenous 
body brought about through the presence of a nitrogenous 
body called a ferment. For its production we require a non- 
nitrogenous substance, a ferment, moisture, presence of air 
(generally), a temperature not exceeding 100° to 110° Fahr. 

Enzymes are soluble or unorganized ferments acting like 
yeast and other recognized ferments. They are of both vege- 
table and animal origin. Those of animal origin are found 
in digestive fluids, as pepsin in gastric juice., ptyalin in saliva. 

Differentiate chemically sucrose, glucose, lactose and 
maltose. 

Sucrose, C 12 H 22 O n , does not reduce cupric salts. 
Glucose, C 6 H 12 6 , reduces cupric salts. 
Lactose, C^H^OnILjO, polarizes light to the left. 
Maltose, C^H^O^ELA very soluble in water. 

Complete the following equations: 

FeCl 3 + 3NH 4 OH = 



CHEMISTRY. 417 

MgCl 2 + NH 4 C1 + Na 3 P0 4 = 

FeCl 3 + 3NH 4 HO = Fe3H0 + 3NH 4 C1. 

MgCl 2 + NH 4 C1 + Na 3 P0 4 = NH 4 MgP0 4 + 3NaCl. 

Describe oxygen as to occurrence, preparation, physical 
properties, chemical properties, office in the body. Give 
the chemistry of the ordinary candle flame. 

Oxygen occurs mixed with nitrogen to form atmospheric air. 
It is found chemically combined with y 8 of its weight of 
hydrogen in water. It is present in many compounds, as the 
oxids, oxy-acids, oxy-salts, hydrates in both mineral and or- 
ganic compounds. 

It is the most widely distributed of elementary substances, 
and constitutes one-third of all matter. 

It is prepared by heating a mixture of potassium chlorate 
and manganese dioxid. Physically, oxygen is a colorless, 
tasteless, odorless gas, slightly heavier than air, its specific 
gravity being 1.1056. It is soluble to the extent of 3 per cent, 
in water. It can be liquefied, when it resembles water, and 
when solidified appears like ice. 

Chemically, oxygen supports combustion, does not burn, is 
strongly electro-negative, is of diad valency, combines chem- 
ically with all elements excepting fluorin and argon. 

It supports animal respiration; it is carried by the red 
blood corpuscles to every tissue of the body, upon which it 
acts destructively to allow of constant regeneration of tissues. 

It is used remedially where from any cause respiration is 
impaired or prevented. 

The ordinary candle flame presents three zones or portions. 
The inner zone, colorless, is composed of hydro-carbon vapors, 
and has but low temperature. 

The second zone consists of solid particles of carbon heated 
to incandescence by the burning of the hydrocarbon vapors. 
This is the true illuminating flame of the candle. 

The third zone consists of a dark surrounding envelope of 
burning vapors, in which free carbon undergoes more or less 
complete combustion; this zone contains carbon-dioxid gas 
27 



418 CHEMISTRY. 

and water vapor, and its temperature is not so high as the 
second zone. 

When a candle burns it gives rise to free carbon, carbon- 
dioxid and water. 

What is chJorin? How is it prepared? How is chlorin 
administered medicinally through the mouth? 

A heavy green gas about 2y 2 times the weight of air, freely 
soluble in water, generally administered in watery solutions 
known in pharmacy as aqua chlorini. 

Prepared by heating a mixture of manganese-dioxid and 
hydrochloric acid, and collecting the gas evolved by displace- 
ment. 

Mn0 2 + 4HC1 = MnCl 2 + 2H 2 + Cl 2 

Define alloy, amalgam. Give an example of each. 

An alloy is a combination of two or more metals. Example : 
Brass, an alloy of zinc and copper. An amalgam is an alloy 
in which one of the metals is mercury. Example : Tin amal- 
gam, composed of tin and mercury, used in making of mirrors. 

How is hydrogen sulfid formed in nature? How is 
hydrogen sulfid prepared in the laboratory? 

It results, in nature, from the decomposition of organic 
matter containing sulfur in the presence of moisture. Ex- 
ample: The rotting of an egg gives rise to hydrogen sulfid 
from the union of the sulfur in the albumen with the hydrogen 
of water. 

Hydrogen sulfid may be prepared in the laboratory by 
adding dilute sulfuric acid to ferrous sulphid, as 
FeS + H 2 S0 4 = FeS0 4 + H 2 S. 

Explain the significance of the following prefixes: 
Hydro, sub, hyper, nitro, bi. 

Hydro indicates the presence of hydrogen in chemical com- 
bination with another element. Hydro-chloric acid, HC1, 
affords an example. 

Sub refers to a compound in which a less number of atoms 
so designated are present in a molecule than the number of 



CHEMISTRY. 419 

atoms of the other body that is present. Example: Ag 2 0. 
Sub-oxid of silver takes its name from the fact that there is a 
less number of oxygen atoms than of silver atoms. 

Hyper has an opposite significance to sub, as C1 2 7 is called 
hyper-chloric oxid to distinguish it from C1 2 5 , called chloric 
oxid. 

Hyper here implies a greater amount or larger - number, 
referring in this instance to the number of oxygen atoms that 
exist in chloric oxid. 

Nitro indicates the presence in a compound of the radical 
N0 2 , as C G H 7 (3N0 2 )0 5 as tri-nitro-cellulose. 

Bi indicates two atoms of the element so designated in 
chemical combination with another element, as CS 2 means 

bi-sulfid of carbon. 

i 

Mention the metals whose salts are often taken as 
poisons. 

Silver, lead, mercury, arsenicum, antimony, copper, tin, 
zinc, barium. 

What is common salt? State where and how common 
salt is obtained, and give the chemistry of its use for 
freezing purposes. 

Sodium chlorid, NaCl. 

By evaporation of sea water. 

By evaporation of water in which sodium chlorid is dis- 
solved, as in natural mineral springs, and this brought about 
through flooding cuttings that pass through a salt bearing 
stratum of rock, and then evaporating such water. 

Large quantities of salt are obtained from the vicinity of 
Syracuse. 

When salt is mixed with snow or ice it occasions the rapid 
liquefaction of the snow or ice, and in this act heat is rendered 
latent, and heat so rendered latent is extracted from bodies 
near the liquefying ice. 

Explain the formation of a vesical calculus having a 
uric acid nucleus. 

An aggregation of uric acid crystals, from their sharp 



420 CHEMISTRY. 

angular character, produce much irritation to vesical mucous 
lining, so that they become surrounded with deposits of mucus, 
and then, from inflammation produced, we may have decom- 
position of urine, which acquiring an alkaline reaction occa- 
sions formation and deposition of alkaline urates, or perhaps 
phosphates, around the original mass, thus forming a mixed 
calculus. 

Give two tests for morphin. 

Touch the suspected alkaloid with nitric acid, and if it be 
morphin it dissolves, yielding an orange-red liquid that soon 
fades to yellow. 

To morphin add neutral ferric chlorid solution— a blue 
color is produced. 

When are substances said to be (a) isomeric, (b) meta= 
meric, (c) polymeric. 

Bodies are truly isomeric when they are made up of the 
same elements in the same percentage proportion and have 
the same molecular formulae, containing the same elements or 
radicals, but such elements or radicals uniting in different 
groupings give rise to different bodies. 

Two or more bodies are metameric when composed of the 
same elements in the same percentage composition and have 
the same molecular formulae but contain different radicals. 

Polymeric bodies are composed of the same elements in the 
same percentage composition but show different molecular 
formulae. 

Write a reaction for making barium sulphate from 
sodium sulfate. How many grams of sodium sulfate are 
required to yield 2.33 grams of barium sulfate by this pro= 
cess? (Atomic weight of barium equals 37.) 

Na 2 S0 4 +.BaCl 2 = BaS0 4 + 2NaCl. 
142 Na 2 S0 4 make 233 of BaS0 4 . 

If 233 grams of barium sulfate require 142 grams of sodium 
sulfate, then 233 : 142 : :2.33 :X, or 1.42. 

Result, 1.42 grams of sodium sulfate required. 



CHEMISTRY. 421 

Describe and illustrate (a) monobasic acid, (b) dibasic 
acid, (c) tribasic acid. 

(a) An acid containing one atom of hydrogen that is cap- 
able of being replaced by a metal or an electro-positive rad- 
ical, as HC 2 H 3 2 , acetic acid; AgC 2 H 3 2 , argentic acetate. 

(b) An acid which contains two replaceable hydrogen 
atoms in each molecule, as H 2 S0 4 , sulfuric acid; Na 2 S0 4 , 
sodium sulfate. 

(c) An acid which contains three replaceable hydrogen 
atoms in each molecule, as H 3 P0 4 , phosphoric acid; Na 3 P0 4 , 
basic sodium phosphate. 

Write chemical equations showing two methods of 
obtaining hydrogen. 

Zn 2 + 2H 2 S0 4 = 2ZnS0 4 + 2H 2 . 
Zn 2 + 4KHO = 2K 2 Zn0 2 + 2H 2 . 

What is the meaning of the words monad, tetrad and 
pentad? Give an example of each. 

Monad refers to an element or compound radical whose 
power of combination by volume is the same as hydrogen 
exhibits. That is, one quart of the substance would combine 
with one quart of hydrogen if such chemical union were pos- 
sible and the elements were in a gaseous condition. Thus 
chlorin is a monad, as it combines with hydrogen in equal 
volumes, and theoretically it is claimed that this combination 
takes place with one atom of H uniting with one atom of 
chlorin. 

Tetrad is an element or compound radical exhibiting a com- 
bining power four times that possessed by hydrogen, or it is 
an element that would require four times its own volume of 
hydrogen to completely satisfy its desire for chemical union. 
Example : Carbon, as in marsh gas,CH 4 . 

A pentad exhibits in its atom a desire to combine with five 
hydrogen atoms, or five atoms of a monad substance. Ex- 
ample: Phosphorus, as in its compound phosphoric chlorid, 
PC1 5 . 



422 CHEMISTRY. 

Describe cyanogen and its principal compounds. 

Cyanogen, C C N G ; symbol, Cy or CN. 

This body is an organic compound radical composed of 
equal volumes of carbon and nitrogen vapors. Cyanogen is 
studied in its molecule. It is a colorless, inflammable gas, 
soluble in water. It exists in a divided form in many vege- 
table structures, as in peach kernels. It is electro-negative 
or acidulous, is of monad valency, acts like chlorin in chemical 
compounds which it forms. 

Important compounds: Hydro-cyanic acid, HCN. In one 
per cent, watery solution, called prussic acid. Very poison- 
ous, colorless, water-like liquid. 

KCN, potassium cyanid, used in doses of % grain for same 
purposes (sedative) as hydrocyanic acid. 

Potassium ferro-cyanide and potassium ferri-cyanide have 
considerable use in arts and manufactures. 

Nickel-cyanide, silver and gold cyanide are all used for 
electro-plating purposes. 

What is the source and principal properties of vaseline? 

Vaseline is a fat-like mass of from white to yellow color, 
obtained by purifying the residue, after distilling the more 
volatile substances, from petroleum. 

It is more or less fluorescent; it melts at from 104 to 125 
degrees Fahr. It is almost odorless and tasteless. 

Give the general characteristics of the aluminum group 
of elements. 

Metals of aluminum group include aluminum, indium, gal- 
lium. They are tri-valent, forming compounds like MC1 3 or 
M 2 3 . Here M stands for the aluminum or similar metal. 

Their oxids are weak bases; their sulfates of alkali metals 
form double salts called alums, which crystallize in the regular 
isometric system. 

Oxids and hydrates are insoluble in water, as are the phos- 
phates and carbonates of these metals. 



CHEMISTRY. 423 

Give a typical example of each of the following classes 
of mineral waters: (a) Saline cathartic, (b) alkaline, (c) 
sulfurous. 

(a) Epsom spring water (England), containing magnesium 
sulfate. 

'(b) Buffalo lithia water, containing lithium carbonate. 

(c) Waters, natural, in vicinity of volcanoes, as in Island of 
Sicily, Iceland, the Yellowstone; such water contains sulfur 
dioxid gas in solution. 

Describe one of the processes by which HCI and N may 
be prepared. 

HCI is prepared by heating sulfuric acid and common salt 
and passing the evolved gas into water. 

N is prepared by passing air over copper heated to redness. 
The oxygen being retained by the copper allows the nitrogen 
to pass at the distal end of the outlet tube. 

Explain the difference between the Fahrenheit, centi= 
grade and Reaumur thermometers. 

The freezing point of water in the Fahrenheit scale is 
marked 32 degrees, while in centigrade and Reaumur scale 
this point is marked zero. The boiling point in the Fahren- 
heit scale is 212 degrees, the centigrade scale 100 degrees, 
Reaumur 80 degrees. It will thus be seen that between the 
freezing and boiling point of water in the F. scale we have 
180 degrees, in C. scale 100, in R. 80. Hence each degree F. 
would correspond to 5-9 of a degree C. and 4-9 of a degree R. 

What is litmus? Explain its uses in urinalysis. 

Litmus is a vegetable substancce obtained from a species of 
lichen. 

It is sold in the shops in small blue cubes. It is obtained 
by subjecting the plant to the action of alkaline solutions, 
evaporating, and adding plaster of Paris. It dissolves in 
water ; its color, owing to its formation through the use of an 
alkali, is blue, it gives blue solutions, it stains bibulous paper 
blue, it is turned red on contact with acids. Its color is due 



424 CHEMISTRY. 

to the presence of a weak acid, while the salts formed by 
the union of this acid with bases are blue. In urinalysis we 
use it generally in the form of- litmus paper to determine the 
reaction of urine. 

Give the chemical differences between chloral and chlo= 
roform. 

Chloral is aldehyde, in which three atoms of hydrogen of 
an alcohol radical have been replaced by chlorin atoms, as 
alcohol, C 2 H 5 OH ; aldehyde, C 2 H 3 OH ; chloral, C 2 C1 3 0H. 

It is tri-chlor-aldehyde. 

Chloroform is tri-chlor-methane, or marsh gas, in which 
three hydrogen atoms in each molecule are replaced by chlorin 
atoms, as marsh gas, CH 4 ; chloroform, CHC1 3 . 

Chloral contains oxygen in its composition; chloroform 
does not. 

Complete the following equations: 

CaCl 2 + (NH 4 ) 2 C0 3 = 

CH 4 N 2 + 2H 2 6 = 

CaCl 2 + (NH 4 ) 2 C0 3 = CaC0 3 + 2NH 4 C1. 

CH 4 N 2 + 2H 2 6 = (NH 4 ) 2 C0 3 . 

Define malleability, endosmoses, dialysis. 

Malleability refers to the property possessed by metals of 
being hammered or rolled out into thin sheets. Endosmosis 
refers to the act of a liquid of a certain density passing inward 
through a porous partition to mix with a liquid of different 
density on the interior of the porous partition. 

Dialysis is the operation of separating crystalloids from 
colloids when both are in the same solution through the prop- 
erty possessed by crystalloids of readily passing through an 
animal membrane out into a vessel containing distilled water, 
while the colloid does not pass through the animal membrane 
forming the bottom of a vessel known as a dialyzer. 

Give the general characteristics of rain water, well 
water, river water and lake water. 

In order of usable quality we would rank 



CHEMISTRY. 425 

Rain water, pure. 

Well water, impure. 

River water, suspicious. 

Lake water, good. 

Rain water is always soft, well water and river water gen- 
erally hard, lake water usually soft. 

In well water we are apt to find impurities deposited from 
the soil or carried through the action of rain, from stables, 
and other deposits of filth, into the general well contents. 

This is particularly true in the case of shallow wells. 

River water is apt to be contaminated by sewage and waste 
from cities and manufacturing plants, from the facility river 
currents offer for the disposal of waste material. 

Rain water may be very impure at first of a storm, but after 
a few minutes, impurities, dust and other material, having 
b»een washed from the air, then should rain water be collected ; 
it affords the purest natural supply. 

Lake water, unless near settled communities, contains only 
harmless vegetable contamination. 

Give the method of preparation and the special char=» 
acteristics of ozone. 

It may be prepared by passing moist air or oxygen through 
a "Siemens" induction tube, while the tube has traversing 
it silent electric discharges. 

So prepared, ozone is a blue gas of very irritating effect 
-upon respiratory mucous surfaces, of very active oxidizing 
and corroding action, acting directly to cause oxidation of 
substances that ordinarily resist the action of oxygen, as silver. 

Test for ozone : Bibulous paper is saturated with a mixture 
of starch mucilage and potassium iodid solution. 

This paper will be turned blue in contact with even minute 
traces of ozone. 

What is fluorin and where is it obtained? State the 
preparation and the practical uses of hydrofluoric acid. 

Fluorin is a yellow gas, slightly heavier than air, is electro- 



426 CHEMISTRY. 

negative, cannot be forced to combine with oxygen, has marked 
affinity for hydrogen and for some of the metals. 

It occurs in nature in combination with metals as fluorids, 
as the fluorid of calcium or fluorspar, CaF 2 . 

Hydrofluoric acid is made by heating calcium fluorid and 
sulfuric acid in a leaden vessel and passing the evolved gas 
into water, in which it readily dissolves. This gives us a 
watery solution of hydrofluoric acid. Its chief use is as a 
solvent for glass ; from this action it is known as the etching 
acid. 

It is also used in the manufacture of peroxid of hydrogen. 

What are the constituent parts of boroglycerid and what 
is its use in medicine? 

Boroglycerid is an ether obtained by boiling boric acid in 
glycerin. 

U. S. P. Glyceritum boroglycerini, 31 per cent, boric acid 
dissolved in glycerin. 

It is antiseptic and detergent. 

What are the properties of lead? What is litharge? 
Give the toxicology of lead. 

Lead is a soft, heavy, bluish-white metal. Atomic weight, 
206. Melts below a red heat, oxidizes when heated in air to 
form yellow oxid of lead or litharge. 

Lead is soluble in nitric acid, in acetic acid, in very strong 
hot sulfuric acid. Exposed to air a basic carbonate of lead 
forms upon the surface. Same occurs in water containing 
carbon-dioxid. 

Litharge is monoxid of lead, PbO. It is yellow in color; 
obtained by heating lead (melting) in air. 

Antidote for soluble lead salts is a soluble sulfate, as Epsom 
salt. 

Lead may occasion acute or chronic poison. 

In acute lead poisoning we have the action of an irritant — 
vomiting, purging, abdominal cramps, etc. 

Chronic lead poisoning, as it occurs in painters or those 
constantly exposed to the fumes of lead and its compounds, 



CHEMISTRY. 427 

is characterized by paralysis of extensor muscles, producing 
"wrist-drop" in the case of painters; also many obscure ner- 
vous symptoms, paralyses, anesthesias, etc. 

Give the preparation, formula and characteristics of 
bromid of ammonium. 

Bromid of ammonium may be thus obtained : 

Place one pound of bromin in a stone jar, add to it care- 
fully four times its weight of water, then add half ounce at a 
time, very slowly, one quart of ammonia. The resulting 
solution from crystallization or granulation will yield ammo- 
nium bromid. 

6Br + 8NH 3 = 6NH 4 Br + N 2 . 

Formula of ammonium bromid, NH 4 Br. 

It is a white cubical salt, soluble in water; heated with 
caustic soda evolves odor of ammonia. 

Passing chlorin gas through its water solution we have 
bromin disengaged. 

Ammonium bromid acts upon the system like potassium or 
sodium bromid, as a depressant to the motor function of spinal 
cord. Its chief uses are to produce sleep and allay nervous 
irritability. 

Give a description of the preparation and mention the 
properties of the principal alcoholic beverages obtained 
from the fermentation of malted grains. 

The brewer "mashes" the ground malt with water, and 
heats at about 180 degrees F. for several hours, when such 
starch as has not been changed by germination of the grain 
in the malt now undergoes change into dextrin and sugar. 

The liquid resulting is ' ' wort. ' ' 

Wort is now boiled with about T V as much hops as was used 
of malt originally. 

This hopped wort is allowed to stand and the clear portion 
drawn off in shallow coolers, and its temperature lowered to 
about 60° F. Then about T ^ of its volume of yeast is 
added and the liquid allowed to ferment in large vessels or 
tuns. As the result of fermentation glucose is changed to 



428 CHEMISTRY. 

alcohol, with a further formation in the liquid of lactic, suc- 
cinic, carbonic and acetic acids, glycerin, etc. 

The fermentative process is now stopped by heating the 
liquid sufficiently high to kill the yeast plant (Pasteurizing). 
Ale, porter, stout, differ from beer only in the selection and 
proportion of the malt, hops and flavoring material. 
Beer. Stout. Ale. 

2.78 6.66 6.25 Alcohol 

6.05 7.24 6.98 Solid extractive 

.12 .20 .14 Free acid 

What is the normal amount of uric acid excreted in 24 
hours by an adult, and what effect has diet on the quantity 
so excreted? 

About 10 grains in 50 ounces of urine excreted in 24 hours. 
(Holland.) 

Increased during a diet rich in nitrogen, as of meats, peas, 
beans, eggs, etc., and alcoholic beverages. 

What is the fever thermometer? How is it made and 
graded? 

A small glass thermometer of a minute capillary bore, with 
a constriction in the lumen of the capillary tube immediately 
above the mercurial chamber. 

The mercury, in its expansion, passes through the con- 
stricted parts of the tube, but on cooling and contracting 
cannot, by its own weight, fall down the tube past the con- 
stricted portion. 

It is made like other thermometers by certain steps. 

1st. Calibrating the tube. 

2d. Filling the tube. 

3d. Curing the tube. 

4th. Graduating the thermometer. 

It is usually graduated from 90 degrees Fahr. to 110 de- 
grees Fahr. Each degree divided into five equal spaces. 

What is the relative importance of the element carbon 
in organic chemistry? 

All organic compounds contain carbon. 



CHEMISTRY. 429 

It is the essential, necessary element whose presence classes 
the body as organic. 

Inorganic compounds occur in small number that contain 
carbon, as in the salts known as carbonates and bi-carbonates. 

What are the chief substances known as protein bodies 
or albumenoids? 

Albumen, as of eggs, meat, gluten of flour, etc. 

In testing the urine by heat in a case of suspected a!bu= 
minima, what substances might be precipitated and so 
make the test deceptive? 

Phosphates. 

Describe the chemical process (a) when iron rusts, (b) 
when wood burns, (c) when silver is tarnished by coal gas. 

In rusting of iron the final product is Fe 2 3 , ferric oxid. 

Wood burns to form carbon-dioxid and water. 

The carbon and the hydrogen of the wood uniting with 
oxygen from the air and from the wood itself when influenced 
by heat. 

Silver, in presence of coal gas, becomes coated with a black 
sulfid of silver, Ag 2 S, from the presence in the coal gas of 
sulfur gases, as hydrogen sulfid and ammonium sulfid. 

How is collodion prepared and what are its uses? 

Collodion is a gun cotton, made, however, through the 
action of dilute nitric and dilute sulfuric acids upon clean 
raw cotton. 

This substance is dissolved in ether, and its etherial solu- 
tion when painted upon denuded surfaces deposits a coating 
of collodion as a protective to such surfaces when the ether 
evaporates. 

Mention the properties of mercury, and also two of its 
uses. 

Mercury is the only liquid metal. Is silver- white in color, 
solidifies at minus 39 degrees Fahr., boils at 662 degrees. 
It dissolves readily in nitric acid and sulfuric acid. 



430 CHEMISTRY. 

It has the power of dissolving most metals to form amal- 
gams. Its specific gravity is nearly 13.5 compared with water. 

It is volatile at all temperatures, and is electro-positive in 
condition. 

It is used in making thermometers, and to coat the zincs 
of galvanic batteries with an amalgam of zinc to prevent the 
development of local currents in the working of the battery. 

Describe the manufacture of illuminating gas. 

Soft coal is heated in closed retorts, and the resulting 
vapors from its decomposition pass into : 

1st. A hydraulic "main," which is a large pipe half filled 
with water; the gases passing into the water immerge, and 
traveling along the upper portion of the main then pass into, 

2d. Out-air condensers, which consist of tubes in the outer 
air, placed in perpendicular stacks. Then having traversed 
the out-air condensers the gas is conducted into the 

3d. Scrubbing room, in which it comes in contact with thin 
films of water, and is in this manner washed and freed of 
certain substances, the most important being ammonia. The 
gas now passes into 

4th. The lime chamber, where the gas is freed of sulfur 
compounds through the action of lime, sulfate of iron and 
charcoal. After all of these methods of purification, the re- 
sultant is then stored as illuminating gas for distribution to 
the consumer. 

In the retort is left gas carbon and coke ; from the hydraulic 
main and out-air condensers coal tar is removed. 

From the scrubbing room ammonium hydrate is obtained. 

From the lime chamber calcium sulfid is obtained. 

Mention the antidotes applicable in cases of poisoning 
from (a) caustic alkalies, (b) carbolic acid. 

(a) Vinegar, lemon juice, oils, fats, mucilaginous drinks. 

(b) Soluble sulfates, as magnesium sulfate, oils, fats, albu- 
men, vinegar, and alcohol. 



CHEMISTRY. 431 

Where is oxygen found in the human body and what are 
its important uses in the animal economy? 

It is present in moisture, hence in all animal tissues and 
fluids. 

It is also found in many salts and compounds, both inor- 
ganic and organic. 

Oxygen promotes the destruction and removal of existing 
tissues, with subsequent replacement by new structures. 

It is only through the ingestion of oxygen, in respiration, 
that animal life may continue. 

When sulfur is burned in the air, what is the product 
and what are its uses? 

Sulfur dioxid, or sulfurous anhydrid, S0 2 . 

It bleaches organic colors; it is a disinfectant gas. It stops 
or limits fermentation ; in the arts it is used for the manufac- 
ture of sulfuric acid and other chemical bodies. It is used 
in organic chemical analysis and in metallurgy, as in the 
reduction of certain ores. 

Describe bromin. 

A heavy dark red liquid element, vaporizing at all temper- 
atures as an orange-red gas. 

Slightly soluble in water, possessing bleaching and disin- 
fectant powers. It is strongly caustic, electro-negative, monad 
in valency. Atomic weight 80, specific gravity 2.99; pre- 
pared by passing chlorin gas through concentrated solutions 
of bromids. Combines with metal, forms oxy-acids and oxy- 
salts. 

Write the formulas for (a) sodium sulphate, (b) potas= 
sium nitrate, (c) ammonium chlorid. 

(a) Na 2 S0 4 . (b) KN0 3 . (c) NH 4 C1. 

Describe the method of obtaining H and O by passing 
an electric current through H 2 0, and tell how to determine 
which gas is O. 

Seal two platinum wires in the opposite sides of a glass 
flask, solder two upright strips of platinum to these entering 



432 CHEMISTRY. 

horizontal wires. Connect one of the entering wires with the 
positive wire of a galvanic battery of several cells. Connect 
the other wire that enters the glass vessel with the negative 
wire from the battery. Now invert two long glass tubes that 
have been filled with water, in this cup or vessel, that has 
itself been partially filled with water. The water will be 
retained in the tubes through atmospheric pressure, and the 
tubes will be placed, mouth downward, over each of the plati- 
num slips; allow the current to pass, when each tube will fill 
with gas, the water it contains being displaced. The tube 
which will contain oxygen gas fills with but half the rapidity 
of the opposite tube, and if this tube be removed from the 
apparatus and held in an upright position, a fragment of wood, 
glowing, but not actively burning, will kindle into brilliant 
flame when plunged in the tube. 

What is effervescence and what is efflorescence? 

Effervescence refers to the escape of gas through a liquid, 
in which the gas has been held under pressure. This process 
producing bubbling, as we see in soda water. 

Efflorescence refers to the loss of water of crystallization 
which certain crystals undergo when exposed to air. They 
dry out, become powdery, losing their crystalline form, as we 
see in the case of alums. 

What is the chemical composition of the bile? 

Water 91.68 

Mucus and pigment 129 

Glycocholate of sodium 3.03 

Taurocholate of sodium 87 

Soaps 1-39 

Fat : 73 

Lecithin 53 

Cholesterin • -35 

What changes take place in alcoholic fermentation? 

Glucose is converted into alcohol and carbon dioxid gas : 
C 6 H 12 6 = 2C 2 H 5 OH + 2C0 2 . 



CHEMISTRY. 433 

What is understood by specific gravity, and what pre- 
cautions are advisable in the use of the urinometer? 

(a) By specific gravity of a substance we mean the ratio, 
or relation by weight, the substance bears to the weight of 
an equal volume of some substance used as a standard, when 
both substances have the same standard temperature and are 
under normal pressure. 

(b) Bring the temperature of the liquid to be examined 
(urine) to 60° Fahr. ; free the instrument, particularly its 
stem, of any adhering bubbles. Note on the scale of the 
instrument the degree corresponding to the level of liquid in 
the surrounding jar, not recording the degree as shown 
through capillary action in the ascent, up the stem, of a thin 
film of liquid. 

Give the chemical name and formula of (a) water, (b) 
common salt, (c) carbonic acid, (d) nitric acid. 

(a) Hydrogen monoxid, H 2 0. (b) Natrium chlorid or 
sodic chlorid, NaCl. (c) Carbon dioxid gas C0 2 true hydro- 
gen carbonate, H 2 C0 3 . (d) Hydrogen nitrate or hydric ni- 
trate, HN0 3 . 

How does fire=damp explode mines? 

When marsh gas escapes from fissures in coal formations 
and mixes with air such mixtures explode with great violence 
when heated, as from a naked flame of a lamp, the chemical 
results being to form carbon dioxid and water. 

If the proportion of air rises to 18 times the volume of 
marsh gas no explosion occurs. 

Demonstrate the fact that air is mixture, and not a com- 
pound. 

Pass air through water that has been boiled, and 3 per cent, 
of the oxygen of the air will be retained dissolved in the 
water, while less than one per cent, of nitrogen will be retained 
by the water. 

Through this method of solution of oxygen we may entirely 
extract the oxygen from atmospheric air. 



434 CHEMISTRY. 

What is the chemical antidote in case of poisoning by 
(a) mineral acids, (b) tartar emetic? 

(a) Oxid of magnesium, alkaline carbonates. 

(b) Tannic acid. 

What is the formula of sulphuretted hydrogen? What 
are some of its properties and uses? 

Sulphuretted hydrogen, H 2 S, is a colorless gas, slightly 
heavier than air, of a disgusting, rotten-egg-like characteristic 
odor.- Burning with a blue flame when lit in air, it forms 
sulphur dioxid gas and water. 

It is used as a group reagent to separate metals of the so- 
called second analytical group from other metals when all are 
together in solution. 

Which metal is (a) the least tenacious, (b) the most 
infusible, (c) the best for electro=magnets, (d) the best 
for electro=conductors, (e) the most rare? 

(a) Mercury; (b) osmium; (c) iron;(d) silver; (e) radium. 

Describe the process for the preparation of nitric acid. 

Sodium nitrate and sulfuric acid are strongly heated, and 
the resultant gas passing into water, in which it dissolves, 
forming dilute nitric acid, which may be concentrated by 
heating. 

Define and give illustrations of allotropism. 

Allotropism means strange form, and refers to the fact that 
a substance may exist in one or more forms different from its 
usual form and yet be of the same chemical composition. 
Examples: The diamond and graphite are both allotropic 
forms of carbon. Phosphorus presents several allotropic 
forms. 

Give the flame test for barium and strontium. 

"Wet a clean platinum wire with hydrochloric acid, then 
place it in a little powdered barium salt ; hold the wire with 
the adherent barium salt in the inner Bunsen flame, when the 
outer flame will be colored green. 



CHEMISTRY. 435 

Strontium, under like conditions, will communicate a bril- 
liant red color to the outer Bunsen flame. 

What is the per cent, of each constituent present in sul- 
furic acid, the atomic weight of sulfur being 32? 

Hydrogen 2.04 per cent. 

Oxygen. 65.31 

Sulphur 32.65 

What are the principal constituents of milk? 

COWS' MILK. 

Water 87.41 

Solids 11.59 

Fat 3.66 

Sugar 4.92 

Casein 3.01 

Albumen 75 

Albuminoids 3.76 

Ash 70 

To what impurity is the occasional toxic effect of bis- 
muth salts due? 

Arsenic. 

What is the appearance to the naked eye, and under the 
microscope, of urine containing an excess of uric acid? 

Such urine presents a reddish sediment resembling brick 
dust. Under the microscope we have rhombic lozenges with 
two obtuse angles, dumb-bell-shaped crystals, rosettes. 

All of these crystals are of yellow color. 

Give the chemical reason why diabetics should abstain 
from starchy foods. 

Because of the conversion of starch into glucose through 
the action of ptyalin in saliva, and of a ferment in pancreatic 
juice. 

Glucose thus formed cannot be broken up into other sub- 
stances because of loss of power of liver cells to perform func- 
tions, so that this glucose passes directly into the blood, from 



436 CHEMISTRY. 

which it is eliminated after being extracted through the action 
of the kidneys. 

What chemical changes take place as a result of mus- 
cular activity? 

Rapid oxidation of tissues, particularly muscular tissues. 

Increased formation and elimination of urea from decom- 
posed nitrogenous structures. Increased rapidity of circu- 
lation brings formative material to quickly repair this loss or 
waste, so that tissues are rapidly destroyed, rapidly replaced, 
and the waste rapidly removed through exercise. 

What is the difference between fermentation and putre- 
faction? 

Fermentation is the decomposition of non-nitrogenous sub- 
stances due to the presence of a body called a ferment, which 
ferment itself contains nitrogen in its composition. 

Ordinary alcoholic fermentation is accompanied by the 
evolution of carbon dioxid gas. 

Putrefaction is the decomposition of nitrogenous bodies 
brought about through the presence of bacteria, and is char- 
acterized by the evolution of ammonia, and if putrefying 
substances contain sulfur, of sulphuretted hydrogen gas. 

Mention the antidotes applicable in a case of poisoning 
from iodin. 

Starch, mucilaginous drinks, flour, milk, white of egg. 

Describe chloral hydrate. 

Chloral hydrate, C 2 HC1 3 0H 2 0. 

A colorless, transparent, crystalline solid, pungent odor, 
acrid taste, soluble in water. 

Hypnotic. It liquefies if triturated with camphor, phenol, 
menthol, thymol. 

Give a chemical explanation of the souring and curdling 
of milk. 

A ferment, one of the cells of yeast, acts upon the sugar of 
milk, changing it to lactic acid, this lactic acid then producing 
a sour taste and coagulating the casein. 



CHEMISTRY. 437 

Name each of the following: (a) H 2 S0 2 , (b) H 2 S0 3 , (c) 
H 2 S0 4 , (d) H 2 S 2 3 . 

(a) Hyposulfurous acid; (b) sulfurous acid; (c) sulfuric 
acid; (d) thio-sulfuric acid (from which the class of salts 
known as hyposulfites are obtained) . 

What are the chemical constituents of biliary calculi? 

Cholesterine pigments, biliary acids, mucus, epithelium, 
carbonate of calcium, fats. 

Describe your mode of procedure in making a chemical 
examination of suspected urine. 

Determine the specific gravity with urinometer. The re- 
action with litmus paper. 

Note the color, the degree of clearness or presence of pre- 
cipitate or sediment. 

Now test for albumin. 

Fill a test-tube two-thirds full of urine and add to it suffi- 
cient saturated sodium chlorid solution to raise its specific 
gravity ten degrees. 

Add a few drops of acetic acid and boil the upper layer of 
liquid. 

Should it become less transparent it would indicate albumin. 

Then test for glucose, using Fehling's test; then determine 
the relative quantity of indican by use of HC1 and of 
urophain by use of sulfuric acid. 

Then by centrifuge precipitate the chlorids with silver 
nitrate in a percentage tube, the phosphates with ammonium 
magnesium fluid, the sulfates with barium chlorid solution. 

Then estimate urea by hypo-bromite of sodium soltuion. 

Describe the theory of the construction of the metric 
system. 

The metre, unit of linear measure, was supposed to be the 
one ten-millionth of a quadrant of a great circle of the earth. 
The metre is 39.37 inches in length. It is divided into ten 
equal parts called decimetres. 



436 CHEMISTRY. 

Each decimetre is divided into ten equal parts called centi- 
metres. 

Each centimetre divided into ten parts called millimetres. 

Ten metres measure one dekametre; ten dekametres equal 
one hectometre ; ten hectometres equal one kilometre. 

A cubic centimetre of distilled water, at four degrees Cent., 
weighs one gram, the unit of weight equaling, in the English 
system, 15.432 troy grains. 

The gram is divided and subdivided, like the metre, into 
deci-, centi-, milligrams, and we also have the multiples, deka-, 
hecto-, kilograms, referring respectively to 10, 100 and 1000 
grams. 

A cubical vessel with a length of side of one decimetre holds 
one litre of liquid, the measure of capacity. A litre contains 
1000 cubic centimetres, and is nearly equal to the English 
quart. 

Wherein do wine, beer and whiskey differ? 

Wine containing from eight to twenty per cent, of alcohol, 
has present as well compound aromatic ethers and other vola- 
tile principles. 

Beer contains five to eight per cent, alcohol, and has much 
bitter extractive, as from hops, etc. 

Whiskey contains forty-five to fifty-five per cent, alcohol, 
possessing also aromatic substances. 

The skeleton of a man weighs 24 pounds and contains 
58 per cent, of calcium phosphate, Ca 3 (P0 4 ) 2 . Find the 
weight of phosphorus present. (Atomic weight of Ca, 40; 

of P, 31.) 

100% :58% : :24 lbs. :X, or 13.92 lbs. of calcium phosphate. 
Calcium phosphate, molecular weight 310, contains 62 of 
phosphorus. 

310 : 62 :: 13.92 :X = 2.784 lbs. of phosphorus. Answer. 

Distinguish between physics and chemistry. 

Physics is a study treating of the changes that take place 
outside the molecule. The physical forces act between mole- 
cules. 



CHEMISTRY. 439 

Chemistry as a science is a study of the changes occurring 
inside the molecule. 

Chemical forces act between atoms as well as between 
molecules. 

What is the unit of comparison in determining the spe= 
cific gravity of liquids? Of gases? 

Pure water at 4 degrees Cent., or at 60 degrees Fahr. ; 
barometric pressure to be such as would support a column of 
mercury 760 millimetres, or 30 inches, in height. 

This is the standard for determining specific gravity of 
liquids. 

For specific gravity of gases we use pure dry atmospheric 
air at zero Cent, and barometric pressure 760 millimetres, or 
pure dry hydrogen at the same (standard) temperature and 
pressure. 

Define qualitative analysis and give a principal method. 

Qualitative analysis consists of splitting apart the con- 
stituents of a compound, and forming with each constituent 
compounds of a different character that may be readily de- 
tected by the senses. Thus qualitative analysis performed 
upon silver nitrate separates the silver ions from the nitrions 
when to a solution of silver nitrate we add hydrochloric acid. 

And then instantly, when the silver ions are freed, they 
combine chemically with the chlorin ions of hydrochloric acid, 
forming the new body, silver chlorid, which from its insoluble 
character, its color and general appearance permit us to 
recognize its nature. 

Define (a) element, (b) compound, (c) mixture, (d) 
solution, (e) precipitate. 

(a) A substance the molecules composing it being formed 
of the same kind of atoms, (b) A substance the molecules 
forming it containing different kinds of atoms, (c) A me- 
chanical mixture or union of two or more substances, which 
substances may be in any proportion and may retain their 
characteristic properties, (d) A solution is a liquid in which 



440 CHEMISTRY. 

a solid substance, or a gaseous substance, has been dissolved. 
(e) A solid substance insoluble in the liquid in which it forms 
through chemical action. 

Which of the elements are gases at ordinary tempera- 
ture and pressure? 

Hydrogen, oxygen, nitrogen, chlorin, fluorin, argon, and a 
number of lately discovered elementary substances. 

Where do Na, rig, Cu occur in nature? Which occur 
free? 

Copper occurs free in nature, as does also mercury, although 
but in limited quantity. Sodium occurs principally in union 
with chlorin as NaCl found in sea water, mineral springs, in 
natural water, in nearly all plant and animal structures. 

The usual form in which mercury is found in nature is in 
its combination with sulfur in the ore cinnabar, HgS. It is 
found in but few localities, as Spain, Austria, California.. 

Copper often occurs free, called native copper. This is 
the case in the Lake Superior copper region. This metal is 
also found in a number of mineral combinations, as of sulfid, 
carbonate, oxid, etc. 

Describe hydrochloric acid as to its occurrence. 

We find hydrochloric acid present in certain animal fluids, 
as in gastric juice. 

It is found in a few natural mineral waters. 

It occurs in commerce under the name muriatic acid. 

What is the chemical purpose of administering lithium 
compounds in disease attended with excessive formation 
of uric acid? 

To diminish the quantity of uric acid deposits in cases of 
gout and rheumatism, to dissolve uric acid while in the body, 
and to dissolve uric acid calculi. 

How does each of the following affect litmus paper: (a) 
H 2 0, (b) H 2 S0 4 , (c) (NH 4 ) OH? 

(a) No effect, (b) Turns it red. (c) Turns it blue. 



CHEMISTRY. 441 

The quantity of urine being insufficient for the urino- 
meter, how would you proceed? 

Use a small piknometer, or specific gravity flask, some of 
which are of so small a size as to be completely filled when 
containing 25 grains of water. 

Weigh the flask when filled with urine and then when filled 
with pure water. Deduct from each weighing the weight of 
the flask, then divide the weight of the urine by the weight of 
water the flask contains; or, dilute the urine with an exact 
quantity of water, as 3 parts, 4 parts, etc., then use the urino- 
meter, and from the data calculate the true specific gravity 
of the urine. 

Distinguish between starch and sugar. By what his- 
tologic element is starch converted into sugar? 

Starch is colloidal, its formula C G H 10 O 5 . 

It is insoluble in cold water, forms a mucilage in hot water. 
Turns iodin blue, rotates light to the right, has no sweet taste. 

Sugar is crystalline, its formula C 12 H 22 11 . 

It is soluble in cold or hot water, it rotates light to the left, 
it yields no color with iodin, it possesses a characteristic sweet 
taste. 

Starch is converted into sugar (glucose) by ptyalin. 

Complete the equation CaCI 2 + Na 2 C0 3 = 

CaCl 2 + Na 2 C0 3 = CaC0 8 + 2NaCl. 

Mention the antidotes applicable in cases of poisoning 
from (a) oxalic acid, (b) copper sulphate. 

(a) A salt of lime or calcium — lime water. 

(b) Albumin. 

Chemical antidote is ferrocyanide of potassum. 

What is chemical decomposition? 

Chemical decompositon refers to the breaking up of a com- 
pound into simpler forms through chemical action. 

Give an example of a synthetic operation. 

The formation of cupric oxid by heating the metal copper 



442 CHEMISTRY. 

in air or oxygen ; or, mixing two parts hydrogen and one part 
oxygen by volume and heating, an explosion occurs and vapor 
of water is formed. 

What are the products of the combustion of ordinary 
coal? 

Principally carbon monoxid and carbon dioxid. 
There may also arise ammonium sulfid, ammonia, marsh 
gas, olefiant gas and acetylene gas. 

In composition with what elements are the following 
most commonly found in nature: (a) Iron, (b) gold, (c) 
silver, (d) copper, (e) chlorin? 

(a) Oxygen or sulfur, (b) Sulfur, (c) Sulfur, tellurium 
and chlorin. (d) Sulfur, oxygen, carbon, (e) Sodium. 

Describe the production of oxygen by decomposition of 
potassium chlorate. Give the formula and equation. 

Heat potassium chlorate with or without an addition of 
manganese dioxid, and oxygen is liberated from the decom- 
position of potassium chlorate. 

2KC10 3 + heat = 2KC1 + 30 2 . 

Explain an experiment to prove that chemical action 
may be induced by electricity. 

Mix equal volumes of hydrogen and chlorin gases in a flask, 
through the sides of which pass two platinum wires that ap- 
proach near each other in the center flask. 

^Connect these wires with the wires from a battery or induc- 
tion coil, when on sending an electric charge the hydrogen 
and chlorin combine with explosive violence to form hydro- 
chloric acid. 

Name and describe some of the more important potas= 
sium salts. 

Potassium nitrate, crystallizing in regular cubes, is perma- 
nent in air, occurring in large quantities in the soil of hot 
countries. 

Common name is saltpetre, or nitre. 



CHEMISTRY. 443 

Has a large use in arts and industries for many purposes, 
as in gunpowder and pyrotechny manufacture. 

In chemistry it is used as an oxidizing agent. 

Potassium acetate: May be obtained in crystal form by 
chemical action resulting on the addition of acetic acid to po- 
tassium carbonate ; used in medicine as febrifuge and diuretic. 

Potassium carbonate: Obtained by evaporating the water 
with which the ashes of plants have been washed (lixivi- 
ating). 

It is a deliquescent salt. From it many salts of potassium 
may be obtained, as bi-carbonate, by passing carbon dioxid 
gas through a watery solution of carbonate of potassium. 
Potassium iodid : Made by dissolving iodin in watery solution 
of potassium hydrate and evaporating and heating strongly, 
the residue dissolved in water will then yield cubical crystals of 
potassium iodid as the liquid evaporates. This salt is used in 
medicine as an alterative, to promote absorption, and as an 
anti-syphilitic. 

Potassium bromid: Made by union of Br. and KHO, re- 
sembles KI in crystal form and general appearance; used as 
a motor depressor to the spinal cord— a hypnotic. 

What is the formula for (a) chloroform, (b) sulfuric 
ether, (c) alcohol? 

(a) CHC1 3 . (b) (C 2 H 5 ) 2 0. (c) C 2 H 5 OH. 

How would you conduct an autopsy for the purpose of 
testing for arsenic in the stomach and tissues? 

The analytical chemist should be present, if possible, at the 
autopsy. Tie both pyloric and cardiac ends of the stomach 
and place this viscus, with its contents, in a glass jar that is 
chemically clean. Close the jar by a close-fitting glass stop- 
per; seal it, if possible, hermetically, and imprint a design 
upon the seal in such a way that design will be broken should 
the jar be opened. Proceed, in the same manner, to save a 
portion at least of the liver, the small intestine, portion of 
large intestine, the spleen, one kidney, the brain. 

Each of these substances are preferably kept by themselves 



444 CHEMISTRY. 

in clean, well-sealed jars, so sealed that any tampering with 
contents of jar would be at once evident. 

Complete the following equations and write the name of 
each resulting compound under its formula: 

2NaCl + H 2 S0 4 = 

CaC0 3 + 2HCl = 

2NaCl + H 2 S0 4 = Na 2 S0 4 + 2HC1 

Sodic sulphate Hydric chlorid. 

CaC0 3 + 2HCl = CaCl 2 + C0 2 + H 2 

Calcium chlorid -f Carbon dioxid -f water 
How could you determine, chemically, whether a uri- 
nary deposit were composed of urates or phosphates? 

Heat would dissolve a precipitate of urates, but would not 
dissolve phosphates. 

A drop of nitric acid would dissolve a precipitate of phos- 
phates, but would not dissolve urates. 

Mention the antidotes applicable in cases of poisoning 
from (a) mineral acids, (b) corrosive sublimate. 

(a) Magnesic oxid, alkaline carbonates, soap, oil and albu- 
min. 

(b) Give egg albumin, and at once remove the result by 
promoting emesis, or using stomach pump or tube. 

What is dialysis, and how would you construct a dia- 
lyzer? 

Dialysis is the process of separating crystalloids from col- 
loids when both are in the same solution. 

It is performed in a dialyzer, which consists of a glass ves- 
sel, the bottom of which is formed of parchment or parchment 
paper. We place the complex mixture in this vessel of the 
dialyzer and set the dialyzer in a larger vessel containing 
distilled water. 

In a short time the crystallizable substances will have 
passed through the animal membrane forming the bottom of 
the dialyzer into the distilled water, in which they may be 
detected, and from which they may be separated by evapo- 
ration. 



CHEMISTRY. 445 

The colloidal material remains in the dialyzer, not being 
able to pass through the membranous bottom. 

What is the difference between the mercurous and mer= 
curie chlorid? 

Mercurous chlorid, Hg 2 Cl 2 or 2HgCl. 

Mercuric chlorid, HgCl 2 . 

In mercurous chlorid we have chemically a molecule of 
mercury combining with two atoms of chlorin, a white impal- 
pable, insoluble powder, tasteless, odorless, turned black by 
alkaline hydrate solutions. Acts as a laxative. 

Has but slight poisonous action in single dose. 

In mercuric chlorid we have chemically an atom of mercury 
uniting with two chlorin atoms. 

It is a white crystalline soluble substance, of a sweetish, 
burning, metallic taste, turning to a white mixture when 
added to lime-water, giving a yellow precipitate with alkaline 
hydrates. 

Is very poisonous; used externally as antiseptic, and in 
concentrated solutions as disinfectant. 

Administered internally in doses of 1-24 of a grain as a 
maximum, as an anti-specific, alterative, tonic. 

Antidote, albumin. 

What impurities may be present in sulfuric acid, and 
how would you detect them? 

Lead : Appearing when strong sulfuric acid is diluted with 
water, here giving a white precipitate or haziness to the mix- 
ture of sulfate of lead. 

Arsenic : Recognized by Marsh 's test, using chemically pure 
zinc for the work. 

Selenic acid : Showing its presence by communicatinsr to the 
sulfuric acid a power of dissolving gold. 

Nitric acid, or oxid of nitrogen : Detected by testing the sus- 
pected dilute sulfuric acid by adding to it a mixture of strong 
sulfuric acid and carbolic acid, and evaporating these three 
substances in a porcelain dish to dryness, when on heating 



446 CHEMISTRY. 

slightly, should nitrates or nitric acid be present, a pink color- 
ation is observed. 

Organic matter in sulfuric acid causes a darkening of tint 
even to the production of a black liquid. 

What is sulfuric ether, and what is its action upon man? 

It is the oxid of ethyl, (C 2 H 5 ) 2 0, receiving its name from 
the fact that it is obtained by distilling a mixture of alcohol 
and sulfuric acid. It is a colorless liquid, lighter than water, 
readily vaporizing at ordinary temperatures, its vapor being 
heavier than air and of a characteristic odor. Ether pro- 
duces in man, or other animals that inhale it, unconsciousness, 
muscular relaxation, and may occasion death, through a cen- 
tric paralysis of respiration. 

How would you detect the presence of bile in the urine? 

Place urine in test-tube, down which pour fuming nitric 
acid (a mixture of nitric and nitrous acids) so that acid col- 
lects below urine, when, at point of contact, should bile be 
present, a band of coagulation will appear of a greenish 
color; or, 

Add cane sugar to urine, and to a drop or two of this mix- 
ture placed on white porcelain surface, add a drop of strong 
sulfuric acid, when, should bile be present, there will appear 
a play of colors forming in concentric rings, the colors par- 
ticularly prominent, being yellow, red and green. 

Give a reliable quantitative test for albumen. 

Weigh out 100 grains of urine, to it add acetic acid to assure 
its acidity, boil, cool and filter through a weighed filter paper, 
wash the coagulated material on filter paper with : 

1st. Boiling water containing a few drops of acetic acid. 

2d. With ether. 

3d. With alcohol. 

4th. Again with boiling acidified water. 

Then dry in drying oven, temperature of which is not higher 
than 212° F., when weigh on filter paper, and when weight re- 
mains constant between any two successive weighings made 



CHEMISTRY. 447 

at intervals of half hour ; deduct from this weight, weight of 
filter paper, and result gives in grains weight of albumin in 
a hundred grains of urine. 

We wash coagulum with water to remove entangled salts, 
with ether to remove fats or oils, with alcohol to remove color- 
ing matters, resinous substances, etc. 

What is mucin? How would you recognize it in urine? 

Mucin is a compound proteid, and is composed of a proteid 
and a carbohydrate. It will reduce Fehling's solution. It 
occurs in cement substance of connective and epithelial tis- 
sues ; also present in bile and in secretions of mucous surfaces. 

Test: It is not precipitated from urine by boiling, but is 
precipitated on the addition to urine of either alcohol, dilute 
mineral acids, acetic, picric or citric acids. To detect i+ add 
acetic acid to form a layer below urine without heating, when 
at point of contact a poorly defined line of filamentous-like 
deposit will appear. 

Describe the usual method of determining chemically 
the presence of blood in the urine. 

To urine add a few drops of tr. guaiacum and then an ex- 
cess of ozonized ether, shake, the ether separates and becomes 
of a fine sapphire-blue should blood have been present in the 
urine. 

Give a reliable quantitative test for sugar in the urine. 

Select two bottles of about six ounces capacity; in each 
bottle place four ounces of urine, adding to one of the bottles 
a small fragment of yeast. Stopper the bottles loosely and 
place in a warm place, allowing them to remain undisturbed 
for from 12 to 24 hours. Then take the specific gravity of 
the urine in each bottle, and should the specific gravity be 
less in the specimen to which yeast was added it would indicate 
the presence of glucose, which undergoing decomposition into 
alcohol and carbonic acid gas, through the action of yeast, 
will have occasioned a lower specific gravity. Each degree 
of specific gravity thus lost would correspond to the presence 
of one grain of glucose in every ounce of urine. 



448 CHEMISTRY. 

What is alcohol, and how is it formed? 

Alcohol is a hydrate of an alcohol radical ; or an alcohol is 
a water in which one hydrogen atom in each molecule of water 
has been replaced by an alcohol radical. Alcohol is formed 
through that variety of chemical decomposition known as 
fermentation. Alcohol is obtained by distilling the results 
of the fermentation of sugary liquids. 

How is uric acid recognized, chemically? 

Uric acid is recognized chemically by its precipitation 
from urine on the addition of hydrochloric acid. Uric acid 
thus obtained may be washed, dried and weighed. 

A test for uric acid: Concentrate by evaporation a few 
drops of urine, add a few drops of nitric acid, heat until 
dry, when a pink color develops on the sides of the dish; now 
add potassium hydrate, or ammonium hydrate, when a blue 
to purplish color is produced on further heating. This test 
is known as the murexid test for detecting uric acid. 

Name the antidotes in a case of stramonium poisoning. 

Tannic acid, strong infusions of coffee, morphin, physo- 
stigmin, pilocarpin. 

What is the principal pigment in normal urine? 

Urobilin. 

What is hard water, and how would you render it soft? 

Water containing an excessive quantity of dissolved salts. 
To render it soft distil it, boil it, or add to it a strong alkali, 
as washing soda, or milk of lime. 

Give two chemical tests that you would use in water 
supposed to be contaminated by sewage. 

(a) Distil the water until free from ammonia, then add 
acid permanganate of potassium solution to the residue and 
again distil, when should ammonia appear in the distillate, 
as shown by the action upon it of Nessler's solution, it would 
indicate the presence of organic matter in the water examined. 

(b) Estimate the chlorids in the specimen of water, using 



CHEMISTRY. 449 

a standard solution of silver nitrate with potassium chromate 
as an indicator. If it were found that the water contained 
an excessive quantity of chlorids it would point strongly to 
the presence of sewage in such water. 

Give the properties of oxygen. 

A colorless, odorless, tasteless gas, of a specific gravity of 
1.1056 and a density of 16. It is soluble to the extent of 
three per cent, in water. May be liquefied and solidified by 
cold and pressure. Is strongly electro-negative, is diad in 
valency, and combines with all elements save fluorin and 
argon. It supports combustion and animal respiration. It 
is used as a respiratory and general stimulant. 

Give tests for the purity of chloroform. 

Test for chlorin: Drop the suspected chloroform through a 
watery solution of potassium iodid in a test-tube. Should 
the chloroform, which collects at the bottom of the tube, 
acquire a pink color, and the supernatant liquid become yel- 
low or brownish in tint, it indicates the presence of free 
chlorin. 

Test for HC1 : Shake the chloroform with water, and after 
separating pour the water into a clean tube, and rendering it 
acid with a drop of nitric acid, add silver nitrate solution, 
when should hydrochloric acid or chlorids be present a white 
precipitate will form. 

Test for hydrocarbons : Evaporate suspected chloroform on 
clean porcelain surface, when no residue should be left, nor 
should there be any odor save that of chloroform only. 

Test for minute quantities of water : Add to the chloroform 
white anhydrous copper sulfate, when should the copper sul- 
fate become blue in color the presence of water would be indi- 
cated. 

Test for acidity: By shaking the chloroform with water, 
pouring off the water and testing it with a drop or two of 
litmus solution, when a red tint developed would indicate free 
acid. 

29 



450 CHEMISTRY. 

Explain the process of bleaching with chlorin. 

Chlorin only bleaches organic colors in the presence of 
moisture. Chlorin unites with the hydrogen of moisture, 
setting the oxygen free to produce the loss of color. In 
bleaching with chlorin we make use of a mixture of chlori- 
nated lime and water. The fabric to be bleached is first 
"soured" by passing it through a very dilute acid solution. 
It is then placed in the mixture of bleaching salt and water, 
after which it is to be thoroughly washed with proper re- 
agents to remove any excess of acid, chlorin or lime. 

State the most common and convenient antidotes for 
poisoning by mineral acids. State also the course to be 
pursued when the poison to be antidoted is unknown. 

Convenient antidotes for poisoning by mineral acids are: 
Calcined magnesia, alkaline carbonates, as baking soda, chalk, 
soap. Then use oils, fats, milk, flour, eggs. 

If poison be of unknown character administer an emetic, 
as mustard and water, or use stomach pump or syphon tube. 
If reason to suspect poison to be of alkaloidal nature give 
tannic acid or permanganate of potassium. 

Use ammonia, whiskey or strong coffee as stimulants, and 
meet symptoms as they arise. 

How would you make Fehling's solution? 

Dissolve 173 grams of crystallized Roehelle salts in about 
500 cubic centimeters of a sodium hydroxid solution of a 
density of 1.14 ; call this solution No. 1. ^ 

Dissolve 34.64 grams of crystallized copper sulfate in about 
450 cubic centimeters of distilled water; call this solution 
No. 2. 

Slowly add No. 2 to No. 1, stirring well and keeping 
the mixture in perfect solution. When mixed add sufficient 
distilled water to make the completed Fehling's solution 
measure 1000 cubic centimeters. 

Each cubic centimeter of this solution should have its color 
discharged by .005 grams of glucose. 



CHEMISTRY. 451 

If, on boiling Fehling's solution, any change in its color 
takes place, it has spoiled and is no longer fit for use. 

What element composes over half the matter of the 
earth? 

Oxygen. 

What is oxidation? 

Chemical union of elementary bodies with oxygen ; breaking 
up of a compound substance, the elements of which combine 
with oxygen; rapid oxidation, if accompanied by heat and 
light, is called active combustion or burning. 

What is ozone? 

Electrified oxygen, each molecule of which consists of three 
atoms of oxygen; also called allotropic oxygen. It is a blue 
gas of high chemical (oxidizing) powers, irrespirable except 
when extremely diluted, when it acts as a stimulant. 

What is Paris green? 

A double salt of copper arsenite and copper acetate. 
Cu(C 2 H 3 2 ) 2 :3Cu0 4 As 2 . 

Schweinf urt 's green, Mitis green. 

An insoluble green crystallizable powder. 

What is the chemical name of Rochelle salts? 

Bi-tartrate of sodium and potassium, KNaC 4 H 4 6 . 

What is the chemjcal designation of the ordinary alcohol 
of commerce? 

Ethylic alcohol, or the hydroxid of ethyl. 

From what substances is ether obtained? 

Ether results from distilling sulfuric acid and ethylic 
alcohol. 

Name the various states in which matter may exist. 

Solid, liquid, gaseous, and Crook's or radiant state. 

What is the difference between atomic weight and spe=- 
cific gravity? 

Atomic weight refers (as a rule) to the density of elemen- 
tary substances compared with hydrogen as a standard. 



452 CHEMISTRY. 

Specific gravity refers (as a rule) to density of either 
elementary or compound bodies compared to atmospheric air, 
if the substance examined be gaseous. Thus density of oxy- 
gen is 16, while its specific gravity is 1.1056. 

Again, the atomic weight of an elementary substance if 
multiplied by its specific heat gives a product of 6.4 or nearly 
that; while this is not always true of the specific gravity of 
an elementary substance when such specific gravity is refer- 
able to hydrogen as a standard. 

Name and describe a deliquescent salt. 

Auric tri-chlorid. A deliquescent salt is one which when 
exposed to air loses its crystal character, becoming softened,, 
and finally liquefied, through its absorbing moisture from 
the air. 

Complete the following equations: 

(a) 2NH 4 Cl + Ca(HO) 2 = 

(b) 2KN0 3 + H 2 S0 4 =: 

(a) 2NH 4 C1 + Ca (HO) 2 = CaCl 2 + 2NH 3 + 2H 2 

(b) 2KN0 3 + H 2 S0 4 = K 2 S0 4 + 2HN0 3 

Explain the reaction which occurs when the solution of 
the two parts of a seidlitz power are mixed. 

Seidlitz powder consists of Rochelle salts, 120 grains; so- 
dium bi-carbonate, 40 grains; these are. wrapped in the blue 
paper. 

In the white paper is placed 35 grains of tartaric acid. 

H 2 C 4 H 4 6 + 2NaHC0 3 = Na 2 C 4 H 4 6 + 2H 2 + 2C0 2 . 

To what salts do most cathartic mineral waters owe 
their virtues? 

To magnesium sulfate, or to sodium sulfate. 

Explain the construction of the safety lamp used by 
miners, and state the principle involved. 

The flame of the lamp is surrounded by a fine wire gauze, 
the mesh of which is very small. Each individual meoh con- 
tains its film of air, and as air is a poor conductor of heat, the 



CHEMISTRY. 453 

heat of the burning oil is not conducted through the film of 
air in each mesh, the wire of the mesh also assisting in cooling 
the heat of combustion, so that not sufficient heat passes out- 
ward through the wire mesh to inflame the surrounding gas. 

What is pepsin? 

A yellowish or greyish-white powder, soluble in water and 
glycerin, but insoluble in alcohol. It gives none of the re- 
actions of albumin. It is an enzyme, or unorganized ferment ; 
it is the principal ferment found in gastric juice. Its chief 
activity is exerted upon proteid food substances, which it 
assists in converting into peptone. 

Mention the antidote applicable in case of poisoning 
from silver nitrate. 

Common table salt, NaCl. 
What is a chemical symbol? 

A chemical symbol is the initial letter of the name of an 
elementary substance, or it may consist of the initial and one 
other important letter of the name of an elementary sub- 
stance. It is used as a short-hand designation of the element. 

What is the chemical composition of ordinary alum? 

Alum is a double sulfate of aluminum and ammonium. Its 
formula is 2NH 4 A12S0 4 , combining as 

Al 2 3SO + (NHJ 2 S0 4 = 2NH 4 A12S0 4 . 

Write the formula of (a) common salt, (b) nitric acid, 
(c) sulfuric acid, (d) hydrochloric acid, (e) carbonic an- 
hydride. 

(a) NaCl; (b) HN0 3 ; (c) H 2 S0 4 ; (d) HC1; (e) C0 2 . 

What is the simplest test of the presence of (a) an acid, 
(b) iodin? 

(a) l^urns litmus paper red; (b) turns starch mucilage 
bluish-black. 



454 CHEMISTRY. 

Complete the following reactions: 

CaCl 2 + Na 2 C0 3 = 
(C 2 H 5 )HO + C 2 H B HS0 4 == 

CaCl 2 + Na 2 C0 3 = CaC0 3 + 2NaCl. 
(C 2 H 5 )HO + C 2 H 5 HS0 4 =(C 2 H B ) 2 + H 2 S0 4 

Mention a test for ozone. Explain how ozone may be 
prepared in the laboratory, and compare its properties with 
those of oxygen. 

Gives a dark blue color to paper that has been wetted with 
iodid of potassium and starch mucilage. Ozone is prepared 
by subjecting air or oxygen to silent electric discharges, as in 
the "Siemens" induction tube. 

Its properties are like those of oxygen, save that it acts 
more vigorously as an oxidizing agent. 

In concentrated form it is irrespirable. 

Name four elements that enter into the formation of 
organic bodies. 

Carbon, hydrogen, oxygen, nitrogen. 

What preparation of gun cotton is used in medicine, 
and what is its solvent? 

That made through the action of dilute nitric and sulfuric 
acids upon chemically clean cotton. 
Its solvent is ether. 

How may uric acid be obtained from urine? 

By adding to the urine strong hydrochloric acid, when after 
the mixture has stood from 12 to 24 hours uric acid will 
appear in minute crystals. 

Mention the antidotes applicable in cases of poisoning 
from (a) zinc chlorid, (b) hydrocyanic acid. 

(a) Albumin, (b) No chemical antidote (Bartley). 

Use emetics or stomach pump, cold affusions to face and 
neck, inhalation of ammonia; internally administer spirits of 
ammonia, nitro- glycerine, brandy, or inject ammonia in the 
veins. 



CHEMISTRY. 455 

State approximately the equivalent (a) in grains of one 
gram, (b) in fluid ounces of one litre, (c) in inches of one 
meter. 

(a) 15.4; (b) 31 fluid ounces; (c) 39.37 inches. 

Give the formula of (a) alcohol, (b) ether, (c) acetic 
acid. 

(a) C 2 H 5 OH. (b) (C 2 H 5 ) 2 0. (c) HC 2 H 3 2 . 

Mention the elements that, under ordinary circum- 
stances exist as (a) liquids, (b) gases. 

(a) Bromin and mercury, (b) Oxygen, hydrogen, nitro- 
gen, chlorin, fluorin, argon. 

What does the presence of an abnormal quantity of 
chlorin in drinking water indicate? 

1st. Sewage contamination (usual). 

2d. Salt formation through which water has percolated. 

3d. Nearness to sea. 

Give the preparation, formula, properties and uses of 
potassium cyanid. 

Potassium cyanid, KCN or KCy. Prepared by saturating 
potassium hydroxid with hydrocyanic acid. A white amor- 
phous deliquescent salt, easily fusible, and smelling of cya- 
nogen. Very soluble in water, highly poisonous, used for 
same purpose as hydrocyanic acid, used as a cardiac sedative, 
as a sedative addition to cough mixtures. It is often given 
in conjunction with an acid to form a freshly prepared hydro- 
cyanic acid. Its dose does not exceed % of a grain. 

Define valence, radical. Illustrate. 

By valence of an element or radical we refer to its numer- 
ical power by volume in which it enters into chemical union 
with other elements ; thus we say oxygen has a valence of two, 
meaning by this that one quart of oxygen would require two 
quarts of hydrogen (our standard of unity for estimating 
valence) for its perfect chemical union. 



456 CHEMISTRY. 

One quart of chlorin would require but one quart of hydro- 
gen for its perfect chemical union. 

And since this power of combination is noticed in volumes 
it is inferred that ultimate subdivision of the volume, or the 
atom of the element, will possess this power of numerical com- 
bination distinctive with the individual atom. 

A radical is an elementary atom ; a compound radical is an 
unsatisfied or unsaturated group of atoms, as S0 4 . 

What is the formula of carbolic acid? 

C 6 H 5 OH. 

Describe the preparation and properties of nitrogen 
monoxid. 

Nitrogen monoxid is prepared by heating ammonium nitrate 
at temperature not higher than 490° Fahr., and washing the 
resulting gas by passing it in turn through solutions of 
potassic hydrate, ferrous sulfate and water. 

It is a colorless gas, heavier than air, sweet taste, and sup- 
ports combustion, but does not support respiration. 

It is slightly soluble in water, not soluble in hot water. 
May be readily liquefied, when it should be colorless. When 
inhaled by the human subject it produces general anesthesia 
of but very short duration. 

How may phosphorus be obtained? Describe the allo= 
tropic forms of phosphorus. 

Burn bones, and to the ashes add sulfuric acid and water ; 
after standing 24 hours decant the liquid, evaporate it to 
dryness and heat the residue strongly ; to this result add sand 
and charcoal and distil, receiving the resultant vapor under 
water, where it solidifies to yield phosphorus. 

Red phosphorus is less poisonous than the ordinary form. 
It can be obtained by heating ordinary phosphorus in an 
atmosphere of carbon dioxid. It does not dissolve in disul- 
phid of carbon. White phosphorus is noticed coating the 
stick of ordinary phosphorus that is kept under water ; some 
chemists state this to be but one of the oxids of phosphorus ; 
a black allotropic form is also recognized. 



CHEMISTRY. 457 

Give the formula and chemical name of each of the fol= 
lowing substances, indicating those soluble in water: 
Nitre, Epsom salts, lunar caustic, Paris green, aqua fortis, 
gypsum. 

Nitre, potassic nitrate. KX0 3 . soluble. Epsom salts, rtiag- 
nesic sulphate. MgS0 4 . soluble. Lunar caustic, argentic 
nitrate. AgX0 3 , soluble. Aqua fortis. hydric nitrate. HN0 3 , 
soluble. Paris green cupric aceto-arsenite. Cu(C 2 H 3 2 ) 2 : 
3Cu0 4 As 2 . insoluble. Gypsum, calcic sulphate. CaS0 4 , 
2H 2 0. insoluble. 

What is petroleum? What important derivatives of 
petroleum are used in medicine? 

Petroleum or rock oil. A brown colored oil. Generally 
with a green reflection. It comes from the soil, and is due to 
decomposition of organic matter. Some substances derived 
from it include benzine, vaseline. 

What is the chemical designation of nitroglycerin? 
How is nitroglycerin manufactured? 

Glonoin. or tri-nitro-glycerin. A one per cent, alcoholic 
solution of nitroglycerin used in medicine. Nitroglycerin is 
made by cautiously mixing glycerin, strong nitric acid and 
sulfuric acid. 

What are amins? Give an example. 

They are substances which result when the hydrogen of 
ammonia is replaced by hydrocarbon radicals. 

Example : AYhen NH S has one hydrogen atom replaced by 
C 2 H 5 it forms NH 2 C 2 H 55 ethyl amin. 

Define porosity, capillary attraction. 

Porosity refers to that essential property of matter by 
virtue of which spaces called pores exist between the mole- 
cules of all substances, even the most dense. Capillary attrac- 
tion is a modification of adhesion, through which action liquids 
rise in small tubes, to which they adhere or wet : thus through 
capillary attraction oil ascends the wick of the lamp and sap 
travels through tree structure, etc. 



458 CHEMISTRY. 

How do chemical antidotes and physiologic antidotes 
differ in action? Illustrate. 

A chemical antidote seeks to form an insoluble or harmless 
substance by combining chemically with a poisonous substance 
that has been taken into the body ; thus magnesium sulfate is 
antidotal to soluble salts of lead, as it combines chemically 
with lead to form the insoluble sulfate of lead, thus to prevent 
the absorption of lead. An alkaline carbonate is antidotal to 
mineral acids, as it forms, in contact with the acids, harmless 
salts, and destroys the power for corrosion that the acid pos- 
A physiologic antidote acts, not directly upon the 
poisonous body, but after that poisonous substance has been 
absorbed into the blood then the physiologic antidote pro- 
duces symptoms opposed to those which the poison occasions ; 
thus we use atropin as the physiologic antidote to morphine; 
in its action it strongly stimulates respiration that has been 
depressed through the action of morphine. 

Mention two elements of each of the following groups: 
Univalent, bivalent, trivalent, quadrivalent. 

Univalent: Hydrogen and chlorin. 

Bivalent : Oxygen and magnesium. 

Trivalent: Arsenicum and boron. 

Quadrivalent : Silicon and platinum. 

What is the difference between analytic methods and 
synthetic methods in chemistry ? 

Analytical methods seek to tear apart a compound into 
simpler bodies, as heating mercuric oxid, HgO, produces mer- 
cury and oxygen. 

nthetic methods seek to build up a compound or complex 
body by bringing about the union of simpler bodies; thus we 
heat copper in air and form cupric oxid; we dissolve ammo- 
nia gas in water and thus form ammonium hydroxid, NH 4 HO. 

What chemical changes take place in the blood and in 
the air breathed during respiration? 

In respiration, by osmotic action, oxygen passes from the 



CHEMISTRY. 459 

air-sac through its wall and the wall of the adjacent eapillary 
Tessel into the blood ^haTinpl- and finds lodgment upon the 
red blood corpuscle, entering into a loose chemical union with 
:hr iifnr^Li-cin :z ~-~ irrirnsilf :: ::r_ iny-hf-miri: i.n. 
Wh ^ isele reaches the part it is l« .\ ±' f : : flic : ay- 

gen it carries separates from the oxy-hemoglobin. and passing 
through the capillary wall by osmotic action it acts directly 
upon the cells composing the tissue it has reached. 

At the same time carbonic oxid. as a result of oxidation of 
the tissue, passes into the capillary vessel and finds lodgment 
upon and loose chemical union with the hemoglobin, and is 
thus carried by the corpuscle, which has now acquired a 
darkened color and different shape, to the lungs, where again 
by osmotic action the carbon dioxid gases from the hemo- 
globin of the corpuscle pass through the capillary wall into 
the air-sac and are then exhaled in expiration. 

So that air inhaled into the lungs contains its normal quan- 
tity of oxygen, while air exhaled from the lungs is deficient 
in oxygen, but contains a relatively large quantity of carbonic 
:xi.i ci s 

What gases are usually generated during the process :f 
destructive distillation? 

ll lllf .11 ST I'll 111' f 1.1 SI . . . "1 11 . f . - 5 . - ' ~ .- .-. - ^- 

the gases resulting, hydrogen, marsh gas, defiant gas, a 
lene gas. ammonia, sulphuretted hydrogen, carbon monoxid 

in i -'-.-': t : " "v. i 

What is the boiling point. Fahrenheit, of «a> water, b 
alcohol, u"^ mercury? 

(a) 212°. (b) 172°. (c) 675°. 

Describe sulfur, and mention its important compounds. 

Su-fiir is i. iinnn- -.-,-".".;•-• silii -;'.rv iiv.1 - r odor. 

It is strongly electro-negative, is non-metallic resembles 
cen in i:s :iif:n:;i.i ; ;n.'; i i;.i" :ns I: is irsolniir m ~.i:fv. 
slightly soluble in hot aleohoL freely soluble in bi-sulfid of 
carbon. 



460 CHEMISTRY. 

Its valency is 2, 4 and 6. Specific gravity compared with 
water is 2 ; specific heat .2. It crystallizes in octahedrons and 
in right rhombic prisms. It exists in several forms. Its 
compounds are : Many important ores of a binary character, 
as zinc blend, ZnS, cinnabar, HgS, iron pyrites, FeS 2 , galena, 
PbS ; also in hydrogen sulfid, H 2 S. It occurs in ternary 
compounds, in natural substances, as Epsom salt, MgS0 4 , 
Glauber's salt, Na 2 S0 4 , in gypsum or calcium sulfate, in heavy 
spar or barium sulfate. Its important compounds are sul- 
furic acid, sulfurous acid, Nordhauesen, fuming sulfuric acid, 
carbon di-sulfid, ammonium sulfid. Many salts, as sulfates 
of the metals. 

What is boron? Give its principal compounds. What 
is the chemical importance of boron in medicine? 

Boron is a brownish or greyish-black solid, non-metallic 
element. Its principal compounds are boric acid and borax. 
Of boric acid, H 3 B0 3 , we have several modifications, as meta- 
boric acid and pyro-boric acid. An important salt of boron 
is sodium pyro-borate, Na 2 B 4 7 , known chemically also as 
sodium bi-borate, commonly called borax. Boron is only of 
importance in medicine from its two compounds, boric acid 
and borax, both of which are antiseptic, mildly astringent and 
detergent. 

Describe the incandescent electric light, and explain its 
use as an aid to diagnosis in medical and surgical practice. 

The incandescent electric light consists of a thin glass flask 
exhausted of air and containing a filament of carbon or plati- 
num wire coiled in semi-circle or other design, and when a 
current of electricity is caused to traverse this filament the 
resistance it offers to the passage of the current renders the 
filament incandescent, thus giving rise to light. 

The incandescent electric light has a considerable use in 
medicine and surgery for illuminating passages which cannot 
be directly lighted ; thus we use it in the larynx as an aid to 
diagnosis; in the form of the endoscope it is used in 
the bladder. It is used also to illuminate the interior 



CHEMISTRY. 461 

of the stomach, thus facilitating in the detection of hard accre- 
tions, as from tumors, which would give from the outside, 
under these conditions, a shadow effect. 

Give the composition and properties of chloroform. 

Chloroform, CHC1 3 , is obtained by distilling bleaching salt 
of lime and alcohol. It is a colorless, heavy liquid. Its spe- 
cific gravity about 1.5, is of sweet taste, also hot, and has a 
characteristic aromatic odor. It is soluble in alcohol, but 
does not mix to any extent with water, although a minute 
quantity of water may unite with it. 

It burns with a green flame. Its vapor is heavier than air. 
It is used for producing general anesthesia. It is a good 
solvent, particularly for alkaloids and rubber. 

Complete the following equation and give the resulting 
compounds: 

2C 2 H 3 K0 2 + H 2 S0 4 = 

2C 2 H 3 K0 2 + H 2 S0 4 = K 2 S0 4 + 2HC 2 H 3 2 . 

Potassic sulphate. Acetic acid. 
What organic acids are present in vegetables and fruits? 

Citric acid, malic acid, tartaric acid, oxalic acid, gallic acid, 
tannic acid, etc. 

Describe and illustrate the distinction between organic 
and inorganic compounds. 

Inorganic compounds occur in the mineral kingdom, and 
may contain any of the elementary forms of matter; the 
number of atoms in the molecule of inorganic compounds is 
usually small; they do not char when strongly heated, but 
leave a crust or residue called ash when dried from their solu- 
tions. They are generally crystalline. Examples : Sodium 
chlorid, magnesium sulfate, etc. 

Organic compounds all contain carbon, and all except cya- 
nogen contain hydrogen. To these two elements a few other 
elements may be in union, among which we have, as most 
important, oxygen, nitrogen, sulfur, phosphorus. Often the 
number of atoms in each molecule of organic compound is 



462 CHEMISTRY. 

large, though the kinds of atoms be but few ; they all char when 
heated strongly, and burn entirely away on continued heat, 
unless in their composition a metal be present. Examples: 
Alcohol, glycerin. 

Give the chemical composition of (a) Glauber's salt, (b) 
Epsom salt, (c) Rochelle salt. 

(a) Sodium sulfate, Na 2 S0 4 . (b) Magnesium sulfate, 
MgS0 4 . (c) Potassium-sodium tartrate, KNaC 4 H 4 6 . 

Into what two principal groups are elements divided? 
Mention five elements that exist uncombined in nature. 

Into metals and metalloids or non-metals. Oxygen, nitro- 
gen, sulfur, gold, silver. 

Mention the acid constituent of (a) gastric juice, (b) 
the urine, (c) the bile. 

(a) Hydrochloric acid, (b) Acid sodium phosphate (pa- 
thologically uric acid), (c) Taurocholic and glycocholic 
acids. 

What is hemoglobin? On what does its color depend? 

It is the organic coloring principle of red blood corpuscles. 
C 6 ooH 960 -N i 54 177 S 3 Fe. 

It forms a loose union with oxygen, whereby its formula 
shows 179 atoms of oxygen to the molecule instead of 177 
atoms, this additional two atoms of oxygen producing a 
different shape of the corpuscle and giving rise to a bright 
red color. 

Differentiate nitrates and nitrites. Mention two com= 
pounds of each group commonly used in medicine. 

Each molecule of a nitrate contains the acidulous radical 
N0 3 , while each molecule of a nitrite contains the acidulous 
radical N0 2 . 

Nitrates when heated with sulfuric acid give rise to nitric 
acid. 

Nitrites when heated with sulfuric acid yield red fumes of 
the oxids of nitrogen. 

Nitrates when heated alone, or with other substances, part 



CHEMISTRY. 463 

readily with, a portion of their oxygen. Examples of nitrates : 
Nitrate of potassium, nitrate of ammonium. Examples of 
nitrites: Nitrite of amyl, tri-ni trite of glycerin. 

What reaction takes place when chloral hydrate is mixed 
with an alkali? Illustrate. 

There results chloroform, a metallic formate and water. 
C 2 HCl 2 OH 2 + KOH = CHCI3 + KCH0 2 + H 2 0. 

What salt of mercury is soluble in water? Give the 
name and formula of a salt of silver used in medicine. 

Mercuric chlorid, HgCl 2 (bi-chlorid of mercury). Argen- 
tic nitrate, AgN0 3 . 

Describe the test for detecting the presence of strych= 
nin. 

Place a crystal of the alkaloid on a watch glass, and near 
it a fragment of bi-chromate of potassium. Cover each with 
a drop of strong sulfuric acid; after waiting a short time 
draw the two drops of acid together, and where they meet 
will appear a play of colors, in which may be clearly recog- 
nized yellow, red, purple and blue. 

What is a hydrocarbon? What is a sugar? 

A hydrocarbon is an organic compound, the molecule of 
which consists of carbon and hydrogen atoms. 

A sugar is an organic compound of sweetish taste called a 
carbo-hydrate, the molecule of which consists of carbon, hy- 
drogen and oxygen, and the hydrogen and oxygen being 
present in the same relative proportion (atomic) as they 
exist in water. 

What is the faradic current? How is it produced? 

The faradic current, called also the induced current of 
electricity, is developed when through an insulated wire of 
large sectional area a current of electricity flows that is alter- 
nately stopped and restored in its flow as it enters this coil, 
known as the primary coil. Surrounding the primary coil 
is a coil of insulated wire smaller in sectional area but much 
longer, and at the moment of breaking or restoring the electric 
flow into the primary coil currents of electricity are induced 



464 CHEMISTRY. 

in this surrounding secondary coil. These induced currents 
are to and fro currents, that is, they are constantly changing 
their direction of flow; they constitute the true faradic cur- 
rents. 

What is synthesis? Mention three coal tar products 
extensively used in medicine that are prepared in the chem= 
ical laboratory by synthesis. 

Synthesis is the act of constructing a compound or complex 
substance by bringing about the union of simpler bodies. 
Synthetical compounds used in medicine obtained from coal 
tar include salicylic acid, phenacetin, saccharin. 

Differentiate a mass of matter, a chemical compound 
and an elementary body. 

An elementary body is a simple substance that cannot be 
reduced to any simpler form, that is, it is made up of but one 
kind of atom. A chemical compound is the resultant of the 
union of two or more elementary bodies, and it may be, as the 
molecule, infinitely small. A mass of matter is an aggrega- 
tion of either elementary or compound molecules, but of 
sufficient size to be acted upon by molar forces. 

Explain the following terms: Chemical reaction, alkali n 
reaction. Define specific gravity. 

Chemical reaction refers to the union of atoms or radicals 
to form new bodies after, through chemical action, they have 
been separated from their former combinations. A substance 
is said to have an alkaline reaction if when dissolved it changes 
red litmus to blue. Specific gravity means the ratio or 
relation by weight a substance bears to the weight of an equal 
volume of some substance used as standard when both un- 
known substance and standard are under like conditions of 
temperature and pressure. 

Describe some method for (a) analysis of water, (b) the 
synthesis of water. 

(a) Pass water in the form of steam through an iron pipe 
heated to redness, when the oxygen of water will enter into 
chemical union with the iron of the pipe, coating the latter 



CHEMISTRY. 465- 

with magnetic oxid of iron, Fe 3 4 , and hydrogen gas will 
issue from the distal end of the pipe. 

(b) Pass dry hydrogen gas over copper oxid placed in a 
hard glass tube and heat it to redness, when the hydrogen 
will enter into chemical combination with the oxygen, and 
vapor of water will issue from the distal end of the tube, 
while remaining in the tube will be the metal copper. 

State the chemical properties of carbon. Describe two 
allotropic forms of carbon. 

Carbon is an electro-negative solid element, atomic weight 
12. Valency diad and tetrad. It is not a supporter 
of combustion. It combines readily with oxygen to form 
two oxids, carbon monoxid and carbon dioxid. Com- 
bines with hydrogen to form many bodies known in organic 
chemistry as hydrocarbons. It forms binary combinations 
with most non-metals and with a few metal elements. It is 
non-poisonous. 

An allotropic form of carbon is graphite ; this is a greyish- 
black substance crystallizing in hexagonal plates. It occurs 
in large mineral deposits, and, when mined, has great use as a 
lubricant, for making crucibles and to make lead pencils. 
Diamond is another allotropic form of carbon, occurs in octa- 
hedral crystals, is colorless, of high refracting power, is hard- 
est substance known, occurs imbedded often in beds of blue 
clay, as in South African region. When burned in oxygen it 
gives rise to carbon dioxid gas. It is insoluble in all liquids. 

Mention the principal constituents of muscle. 

Water 80 

Solids 20 



Ash 126 

Albuminous 15. 

Etherial extractive 33 

Non-nitrogenous 3.25 

Glycogen 2.43 

Glycosin 71 

30 



466 CHEMISTRY. 

How is the air of an apartment tested to determine the 
presence and amount of carbon dioxid in it? 

Through the neutralizing effect of carbon dioxid upon the 
caustic strength of limewater. 

We determine the caustic strength of limewater in terms of 
oxalic acid solution. We next expose a measured quantity of 
limewater to the action of a measured quantity of atmospheric 
air, when the carbon-dioxid in the air will neutralize in part 
the alkalinity of the limewater. Removing this limewater, 
so changed, we again test its alkalinity by the use of oxalic 
acid solution, using phenol pthalin as our indicator, when 
the loss of alkalinity of the limewater expresses the quantity 
of carbon-dioxid present in the volume of air we have tested. 
This is, in brief, the principle upon which Pettenkof er 's test 
for C0 2 depends. 

Give names and formulas of the salts of iron commonly 
used in medicine. 

Ferric chlorid, Fe 2 Cl 6 ; ferric iodid, Fe 2 I 6 ; ferric sulfate, 
Fe 2 3S0 4 ; ferric acetate, Fe 2 6C 2 H 3 2 ; ferric oxid, Fe 2 3 ; fer- 
rous sulfate, FeS0 4 ; ferrous carbonate, FeC0 3 , etc. 

Mention two salts of mercury commonly used in medi- 
cine. Give their formulas. 

Mercuric chlorid, HgCl 2 . 
Mercurous chlorid, Hg 2 Cl 2 . 

What conditions favor putrefaction? What conditions 
may prevent putrefaction in dead organisms? 

Presence of moisture, warmth, though ^not a higher temper- 
ature than 110° F., bacteria, and a body containing nitrogen 
capable of undergoing putrefaction. Putrefaction may be 
prevented by the exclusion of bacteria or air containing the 
same, by exclusion of moisture, by the preservation of low 
temperatures at or below the freezing point of water, and by 
the use of germicides. 



CHEMISTRY. 467 

Give source, character and uses of atropin. Describe 
the symptoms of poisoning by atropin. 

Atropin is an alkaloid obtained from belladonna leaves. It 
is crystallizable and soluble in water, has a bitter taste, and is 
highly poisonous. Typical symptoms of its poisonous action 
are dilatation of pupil of eye, dryness of throat, flushing of 
face, talkative delirium; later paralysis of centric origin, 
death from paralysis of respiration. Pulse at first slow, hard ; 
later soft and dicrotic, rapid. It is used as midriatic and as 
tonic to increase respiratory and cardiac efficiency. 

Give the properties of common alum. 

It is a white efflorescent crystalline body of a sweetish, 
somewhat metallic, styptic taste. It has heating and mildly 
caustic effects on mucous surfaces, particularly that variety 
of alum that has been heated to rapidly free it from its water 
of crystallization. It is used largely as an astringent and as 
a mechanical emetic. It is soluble in cold water, and far more 
soluble in hot water. It is used as a mordant in dyeing. 

What metallic chemical elements are found in the body 
in various combinations? 

Iron, magnesium, calcium, potassium, sodium, lithium, 
ammonium, hydrogen. 

Differentiate hydracids and oxyacids. 

A hydracid or hydrogen acid is a binary compound com- 
posed of hydrogen and a non-metallic element, as hydrochloric 
acid, HC1. An oxy-acid is a ternary acid containing hydro- 
gen, oxygen and a third element, usually non-metallic (may 
be a metal), as sulphuric acid, H 2 S0 4 . 

Give the chemistry of lithium. 

Occurs as chlorid in the mineral lepidolite; also occurs in 
combination as phosphates and carbonates, frequently found 
in mineral waters. Separated from its compounds, the metal 
lithium is the lightest of metals, being little more than half 
the weight of water. It closely resembles potassium and 



±68 CHEMISTRY. 

sodium, with which it is grouped as an alkali metal. It de- 
composes water in the cold, setting hydrogen free. It is 
strongly electro-positive, is monad in valency, it oxidizes in 
air or water ; it has no commercial use as a metal. 

What is the principal source of urea in the human 
economy? 

Urea is the result of the oxidation of nitrogenized tissues, 
particularly muscular tissue. Urea represents the final 
change of proteid foods after they have served their purpose 
in the economy. 

Give the formula of ammonium chlorid. Describe the 
method of preparing ammonium chlorid. 

Ammonium chlorid, NH 4 C1. It is prepared by saturating 
ammonium hydrate with hydrochloric acid, and evaporating 
the result and allowing crystallization to take place. 

Give the chemical name and properties of (a) cream of 
tartar, (b) plaster of Paris. 

(a) Sodium and potassium bi-tartrate, NaKC 4 H 4 6 . It is 
a crystallizable white salt, soluble in water. 

(b) Anhydrous calcium sulfate, 3CaS0 4 2H 2 0, or every 
three molecules of calcium sulfate have combined two mole- 
cules of water. Plaster of Paris is a white impalpable pow- 
der, practically insoluble in water, but when wet it takes 
sufficient water to revert nearly, but not quite, to its origi- 
nal state of gypsum, CaS0 4 2H 2 0, and in so doing sets to a 
firm coherent mass, and through this action is of use for tak- 
ing impressions or making casts of objects. 

Give the physical and chemical properties of hydro= 
chloric acid. How is hydrochloric acid prepared? 

Hydrochloric acid is a colorless gas, but is best known com- 
mercially and chemically in the form of a solution of this gas 
in water. In this form, when pure, it occurs as a colorless 
liquid, fuming in air, caustic and corrosive action upon or- 
ganic tissues. Specific gravity is 1.2. 

It is a mono-basic hydrogen acid, and in union with bases 



CHEMISTRY. 469 

forms salts called chlorids, which are all, save three, soluble 
in water. 

Hydrochloric acid may be prepared by heating a chlorid, 
as sodium chlorid, with sulfuric acid, and allowing the gas- 
eous HC1 so produced to pass into and dissolve in water. 

State the occurrence in nature and give the properties 
of phosphorus. 

It occurs as a tri-calcic phosphate in apatite and in bone. 
A few other metallic phosphates occur naturally, as of mag- 
nesium. Phosphorus is a wax-like yellow solid element, occur- 
ring in several allotropic forms. It is electro-negative, and 
shows a marked affinity for oxygen. When finely divided it 
takes fire spontaneously in air. It combines directly with a 
number of elementary substances; with iodin or bromin, 
phosphorus will inflame on contact; it exhibits an uneven 
valency, generally acting as a pentad. 

Give the appearance, specific gravity and the odor usual 
to diabetic urine. Describe Fehling's test for sugar in the 
urine. 

Clear, light in color, specific gravity higher than 1025, and 
the odor sweetish, and has been compared to smell of new- 
mown hay. 

Fehling's test: Place one drachm of Fehling's solution in a 
test-tube, heat to boiling, and note that Fehling's solution 
does not change in color, thus proving its fitness for use ; then 
add from one to five drops — not more — of the suspected urine 
and boil, when should Fehling's solution lose its color, or a 
precipitation varying in color from yellow to dark red appear, 
glucose is present in the urine. 

The urine must be freed from albumin, should it be present, 
before performing Fehling's test. 
Complete the following reactions: 
PC1 3 + 3H 2 = 
2NaCl + MgS0 4 == 
PCI3 + 3H 2 = H 3 P0 3 + 3HC1. 
2NaCl + MgS0 4 = MgCl 2 + Na 2 S0 4 . 



470 CHEMISTRY. 

Write a reaction for the preparation of ammonia. 

2NH 4 C1 + CaO = CaCl 2 + 2NH 3 + H 2 0. 
How are the phosphates produced in the animal body? 

The phosphates often exist ready formed in plant foods, as 
in wheat. They are also found in animal structures that 
afford food for the human subject. Phosphates occurring 
naturally in soils are absorbed by the rootlets of plants and 
pass at once to the fruit or grain or seed. 

Should phosphorus in other forms find entrance into the 
human subject it would quickly undergo oxidation, the newly- 
formed oxid would become hydrated, and a combination 
through chemical double decomposition would at once produce 
a salt or phosphate from phosphoric acid. 

Give the symbol, atomic weight and the occurrence in 
nature of bismuth. 

Symbol, Bi. Atomic weight, 208.9. Occurrence chiefly in 
the metallic state, disseminated in veins through various rocks. 
It also occurs in minerals as a sulfid, and it is often found in 
rocks which contain arsenical minerals. 

Give the formulas of the nitrogen acids. How is nitro= 
gen prepared in the laboratory? 

Nitrous acid, HN0 2 . Nitric acid, HN0 3 . 

Nitrogen is prepared by burning phosphorus in a confined 
space of air, when the oxygen chemically combines with the 
phosphorus to form phosphoric and phosphorous anhydrids, 
both of which solidifying, fall to the bottom of the jar, and 
should there be water present, dissolve and enter into 
combination with the water, thus leaving the jar with nothing 
but nitrogen present. 

Give chemical name of (a) common table salt, (b) blue 
vitriol, (c) soot, (d) vinegar, (e) verdigris. 

(a) Sodium chlorid. (b) Cupric sulfate, (c) Carbon. 
(d) Dilute acetic acid, (e) Basic cupric acetate. 



CHEMISTRY. 471 

What reaction of urine favors the deposition of uric 
acid gravel or calculi? What is the reaction of the urine 
during the formation of a phosphatic calculus? 

(a) A strongly acid reaction, (b) An alkaline reaction. 

What is nitroglycerin? Give the medical properties of 
nitroglycerin. 

Nitroglycerin is glycerin in which three hydrogen atoms 
in each molecule have been replaced by three N0 2 radicals. 
It is obtained through the action upon glycerin of a mix- 
ture of strong nitric and sulfuric acids. Its formula is 
C 3 H 5 (N0 2 ) 3 3 . 

It is used medicinally in a one per cent, alcoholic solution, 
acting as a strong, immediately acting cardiac stimulant. 

What is (a) starch, (b) dextrin? 

(a) Starch, C 6 H 10 O 5 , is a white organic carbohydrate, in- 
soluble in cold water, forming a colloidal mucilaginous mass 
in hot water. Gives a blue-black color with iodin. Polar- 
izes light to the left. 

(b) Dextrin, has the same molecular formula, and may 
be obtained by heating the starch. It is soluble in cold water, 
has a somewhat sweetish taste, turns light to the right, and is 
a midway point in the conversion of starch into glucose. 

Define proteid. Give some of the physical character 
istics of proteids. 

A proteid is an organic food principle containing C, H, 
0, N, with perhaps sulfur or phosphorus. It is found in the 
albuminous compounds occurring in both animals and plants. 
It is colloidal and insoluble. It gives an orange-red color 
when boiled with nitroso-nitric acid. Gives a red color on 
contact with sugar and sulfuric acid. 

Describe and state the uses of the thermometer, the 
barometer and the hygrometer. 

A thermometer is a capillary tube containing mercury, and 
nothing else. It is hermetically sealed ; has a bulb at the lower 



472 CHEMISTRY. 

end and a graduated stem above. It is used to determine the 
degree of the intensity of heat. 

A barometer is a glass tube closed at the upper end, the 
lower end immersed in a vessel or cup of mercury. The tube 
above the level of the mercury has been made free of air ; the 
mercury extends from the cup below to a height of 30 inches 
up the tube. The barometer is used to indicate the condition 
of the air, to foretell storms; as the air becomes dry the 
column of mercury rises in the tube to 30 inches in height or 
a fraction above, while upon the occurrence of storm, water 
vapor in the air, prevents the air from supporting a column 
of mercury at this height, so the mercurial column falls. 

A hygrometer is an instrument used to measure indirectly 
the amount of moisture in the atmosphere and to determine 
the dew point of any specimen of air. It consists of two 
thermometers, the bulb of one being kept constantly wetted 
to promote evaporation, the thermometer so treated being 
known as the wet bulb thermometer, and is used to indicate 
the temperature of the dew point. 

Explain the method of producing X or Roentgen rays. 

The X or Roentgen rays are produced by passing a current 
of electricity of high potential, as from an induction coil, 
through a glass tube that has been, as far as possible, ex- 
hausted of air. 

(a) Express in cubic centimetres of distilled water the 
value of one ounce avoirdupois, (b) How many minims 
does a cubic centimetre contain? 

(a) About 30 cubic centimetres. 

(b) About 151/2 minims. 

What is hydrogen sulfid? Show by formulas and equa- 
tion how it is obtained by the action of hydrochloric acid 
on calcium sulfid. 

It is a colorless gas of highly offensive odor and poisonous 
effects. It burns in air with a blue flame to form sulfur 



CHEMISTRY. 473 

dioxid and water. It is slightly heavier than air, and is solu- 
ble in water. 

CaS + 2HC1 = CaCl 2 + H 2 S. 

What salts form the tartar deposited on the teeth? 
From what source is the tartar derived? 

Calcium phosphate, calcium carbonate, bacteria, organic 
matter, salts of the alkalies, and silica. The tartar comes from 
an alkaline saliva. 

What are the properties of antimony? How is it found 
in nature? 

Antimony is a white, highly crystalline metal with a slight 
bluish tint. It volatilizes when heated, forming Sb 2 O a when 
burned in air. 

When powdered it takes fire if dropped in chlorin gas, 
forming a chlorid of antimony. In alloys it increases hard- 
ness, lowers fusion point, gives smoother surface, causes ex- 
pansion of alloy when cooled after fusion, gives rigidity to 
soft metals. It is found native ; it is also found in connection 
with certain metallic ores, as of zinc and copper ; it sometimes 
occurs as sulfld of antimony. 

(a) What is an amorphous substance? (b) What are 
isomorphous substances? 

(a) A dry substance, not occurring in crystalline form, 
(b) Such as although being of the same percentage compo- 
sition of elements yet showing entirely different properties. 

Give uses of the urinometer. State its importance as 
an aid to diagnosis. 

It is used to determine the specific gravity of the urine. 
It is useful in indicating the necessity, or otherwise, for per- 
forming further and more exact tests upon the urine under 
examination. Should the urine vary in its specific gravity 
below 1015 or above 1025, it would at once indicate the abso- 
lute necessity for examining such urine to determine the 
presence or absence of albumen in the first place and glucose 
in the second place. Its record of a high specific gravity in 



474 CHEMISTRY. 

the absence of the glucose gives many indications for the 
prescribing of diet and regimen in cases of disease. 

Describe potassium. Give the names of the principal 
salts of potassium used in medicine. 

It is a silver- white metal, nearly as soft as wax, decomposing 
water in the cold with liberation of hydrogen gas. It oxidizes 
in air and in moisture. When heated to incandescence it 
produces a rose-red, slightly bluish color. The color of its 
vapor is green; it melts below boiling point of water; it is 
lighter than water ; it is one of the strongest of electro-positive 
elements. It is a metal, and is of monad valency. It com- 
bines with the non-metallic elements. Its salts useful in 
medicine include the acetate, citrate, nitrate, chlorate, chlo- 
rid, bromid, iodid, hydrate, sulfate, and carbonate of potas- 
sium. 

Write a chemical equation showing a double decompo= 
sition. 

AgNO ? + HC1 = AgCl + HN0 3 . 

Give the physical and chemical properties of mercury. 
How is mercury obtained from the native ore? 

Mercury is a silver-white liquid metal 13% times heavier 
than water; it is volatile at all temperatures, opaque, insolu- 
ble in water, soluble in nitric acid. Chemically, it is electro- 
positive, and capable of forming two distinct classes of com- 
pounds ; in one of these classes it is thought the molecule of 
mercury combines with other elements or radicals in a diad 
capacity. Such combinations are but slightly poisonous to 
the human subject. 

Another series of compounds represent the atom of mer- 
cury combining as a diad with other elements or radicals and 
forming highly poisonous, very active and unstable com- 
pounds. Mercury is obtained from its principal ore, cinnabar, 
by heating the ore and cooling the resulting vapor of mercury 
and allowing of its deposition in earthenware receivers. 



CHEMISTRY. 475 

Define decay. 

Decay refers, generally, to slow oxidation, causing the 
decomposition of organic substances. The results of de- 
cay favor the union of each element in the substance with 
oxygen. 

Describe distillation, filtration and precipitation as 
applied to processes for purifying drinking water. 

It is impossible to distil water for very many individuals, 
so that this process of purifying is inadmissible for city or 
town. It, however, affords one of the best means at the 
householder's command for purifying water. After distilling 
the water, to fit it for use, it should be aerated by having it 
fall in cascade, in the air, from one vessel to a second one 
several feet below. 

In filtration the impure water passes through a collection 
of stone, gravel and fine sand, and not only are the suspended 
matters removed from such water, but through the action of 
bacteria many organic substances dissolved in the water are 
oxidized and rendered harmless, this action occurring through 
the influence of bacteria settled upon and growing in the 
filtering medium. In precipitation, as applied to purifying 
water, the simplest method is to add alum in not larger quan- 
tity than six grains to the gallon of water. 

The action here is a chemical one, the alum forming a bulky 
hydrate with organic matter present, and this hydrate en- 
tangling and carrying down suspended matters, so leaving 
the water clear. 

What is freezing? State the Fahrenheit freezing point 
of (a) water, (b) alcohol, (c) mercury. 

Freezing or congealing is the name given to the change of 
a liqud to a solid upon the lowering of temperature. 

In this act the molecules are packed closer together, limiting 
their freedom of movement. 

Freezing point of water, 32 degrees Fahr. 

Freezing point of mercury, — 39.4 degrees Fahr. 

Freezing point of alcohol. — 202 degrees Fahr. (absolute). 



476 CHEMISTRY. 

Complete the following equation: 

C 2 H 5 OH + NaC 2 H 3 2 -f H 2 S0 4 = 

C 2 H 5 OH + NaC 2 H 3 2 + H 2 S0 4 --= C 2 H 5 C 2 H 3 2 + NaHS0 4 -f H 2 

Explain the difference between a sulfate and a sulfite. 

A sulfate is a salt, each molecule of which contains the 
acidulous radical S0 4 . 

A sulfite is a salt, each molecule of which contains the 
acidulous radical S0 3 . 

It will therefore be seen that a sulfate differs from a sulfite 
in containing one more atom of oxygen in each molecule. 

Name the elements in the potassium group, and give 
their physical and chemical properties. 

Sodium, potassium, lithium, caesium, rubidium, also the 
electro-positive radical ammonium. 

Excepting ammonium, they are all white metals, the softest 
being but little harder than wax. They melt below the boiling 
point of water, oxidize in air, decompose water, liberating 
hydrogen. All are strongly electro-positive, forming strong 
alkaline bases — oxids and hydrates. Each communicates a 
distinctive color to flame when incandescent. All are of 
monad valency, their carbonates all vaporizing unchanged 
when heated. Carbonates and phosphates of these metals are 
freely soluble in water. 

Describe the element silver, stating its compounds and 
their uses in medicine. 

Silver, a pure white metal, the best conductor of heat and 
electricity. It is the second metal in order of malleability. 
In tenacity it occupies fourth rank. Specific gravity 10.4. 
Ductility second rank. It melts at 1040 Cent., or 1904 Fahr. 
Its atomic weight is 107.7. 

It is used as pure silver wire in surgery. Silver nitrate, 
AgN0 3 , when pure and crystallized is used internally as an 
astringent and alterative. In solution it is locally applied as 
a stimulant or caustic. 

The impure silver nitrate is melted and moulded in sticks 



CHEMISTRY. ±11 

then known as lunar caustic ; has large use in surgery. Oxid 
of silver, Ag 2 0, is used in pill form, internally, as an alter- 
ative and astringent. 

Name four compounds of nitrogen and oxgen, and give 
their formulas. 

Nitrous oxid, N 2 ; nitric oxid, NO; nitrous anhydrid, 
N 2 3 ; and nitric anhydrid, N 2 O . 

What is the presumption as to abnormal constituents in 
urine having a specific gravity of 1005 or less? What 
tests should be applied, and how, to verify the surmise? 

It indicates a greatly decreased excretion of solids by the 
kidneys; this may be due to lack of nervous control over 
excretory function of kidney, as in hysteria, chorea, at crisis 
of acute diseases, etc. 

It may be a polyuria, arising from certain nervous diseases 
or from large imbibition of fluids or watery foods. It may 
be due to such diseased conditions of kidney that have led to 
destructive changes in structure, rendering the kidneys un- 
able to properly excrete solids that should be present in 
urine. Such a low specific gravity always calls for a careful 
examination for albumen, which, if found present, would indi- 
cate a structural disease of the kidneys, if accompanied by 
urinary casts, as seen under the microscope. Tests for albu- 
men have been given. 

What are the differences between common alcohol and 
absolute alcohol? 

Absolute alcohol Common alcohol 

Not more than 1 per cent, water. About 9 per cent, water. 

Specific gravity .797. Specific gravity .820. 

Complete the following equations: 

C 2 H 5 C1 + AgHO = 

CaC0 3 + 2HCl = 

C 2 H 5 C1 + AgHO = AgCl + C 2 H 5 OH. 

CaC0 3 + 2HC1= CaCl 2 + H 2 + C0 2 . 



478 CHEMISTRY. 

What are the physical and chemical properties of S0 2 ? 

It is a colorless gas, dissolving and chemically combining 
with water to form sulfurous acid. It has a suffocating, 
irrespirable odor, can be liquefied and solidified; when lique- 
fied it produces on its evaporation very low temperatures in 
surrounding objects. S0 2 has a molecular weight of 64, and 
is more than twice the weight of air. It will not support 
combustion nor will it burn. It has a powerful affinity for 
moisture, to form by its union sulfurous acid, and this acid, 
slowly absorbing oxygen from air, changes to sulfuric acid. 
Sulfur dioxid is useful as a bleaching agent, a disinfectant 
and for the purpose of destroying ferments or limiting fer- 
mentation. It is a strongly acid anhydrid. 

What is reduced iron (ferrum redactum), and how is it 
obtained? 

It is a chemically pure form of iron occurring in fine pow- 
dery condition. It is obtained by heating ferric oxid to red- 
ness in a hard glass tube, and, while hot, passing through the 
tube dry hydrogen gas, which combines with and removes the 
oxygen, leaving reduced iron in the tube. 

Describe ethyl oxid, giving derivation, ordinary name, 
chemical formula and mode of production. 

Ethyl oxid or ordinary sulfuric ether, or ether, (C 2 H 5 ) 2 0, 
is obtained by the replacement of two hydrogen atoms in a 
molecule of water by two ethyl radicals. It is manufactured 
by distilling a mixture of grain alcohol and sulfuric acid. 

C 2 H 5 OH + H 9 S0 4 == C 2 H 5 HS0 4 + H 2 ; 

Then C 2 H 5 HS0 4 + C 2 H 5 OH==(C 2 H 5 ) 2 + H 2 S0 4 . 

What is the presumption as to abnormal constituents in 
urine having a specific gravity of 1038? 

Such urine will probably be found to contain glucose. 

Give an equation showing the reaction when NH 3 comes 
in contact with an acid. 

NH 3 + HC1 = NH 4 C1. 



CHEMISTRY. 479 

What is the chemical treatment of esophageal and stom- 
ach corrosion from mineral acids? Give an argument 
against the use of the stomach pump in such cases. 

Use oxid of magnesium. Then albumen or oils. 

In such cases the tissues have been so thinned out through 
corrosion that an implement introduced, as a tube from a 
stomach pump, may cause perforation of the denuded tissues 
with fatal results. 

Define emulsion, soap, saponification. 

An emulsion is a liquid holding in suspension oil in very 
finely divided condition, so that the individual drops are 
invisible to the naked eye. There is generally present a sub- 
stance of mucilaginous nature to attain this result. 

A soap is a metallic salt of a fat acid. It is usually a 
potassium or sodium salt of oleic, stearic or margaric acid. 

Saponification is the act of union and solidification of a 
base with the radical of a fat acid. 

Give the sources and explain the uses of benzene. 

C 6 H 6 , benzene. It is found in the lighter oils from the 
distillation of coal tar. 

It is a solvent for fats, oils, resins, and many other organic 
substances. 

It is used as a cleansing agent, and solvent. 

What is an alkaloid? Name three alkaloids used in 
medicine. 

An organic base which always contains nitrogen, posses- 
sing, of course, an alkaline reaction when in solution. It is 
generally of a crystallizable nature, and forms salts with 
acids. The alkaloids of vegetable drugs generally possess the 
activity of the drug substance. Strychnin from nux vomica, 
quinin from cinchona bark, and morphin from opium (dried 
juice of the poppy) are alkaloids of frequent use in medicines. 

State the chemical meaning of the term incompatible. 

Chemically, substances are incompatible when on mixing 
their solutions an insoluble body results, or a new substance 



480 CHEMISTRY. 

having markedly different properties results, or when two 
or more substances, in themselves harmless, form a poisonous, 
explosive or inflammable substance when brought in contact; 
or bodies are incompatible if bringing them together impairs 
their individual characteristic properties. 

State the use and the principle underlying the use of the 
b!ow=pipe. 

The blow-pipe serves to provide a jet of flame of extremely 
high temperature, and of complete combustion, through the 
mixing of air with gas before the latter burns. 

The blow-pipe serves to concentrate at a particular point 
very high temperature. 

Define electricity. 

Electricity is that physical force which manifests itself by 
producing attraction or repulsion between certain substances, 
and gives rise to heat, light, magnetism, chemical action and 
explosive or disruptive effects. 

(a) In what compound is sodium most abundant? (b) 
In what calcium? (c) In what hydrogen? 

(a) Sodium chlorid. (b) Calcium carbonate, (c) Water. 
What is glycerin, and how is it obtained? 

Glycerin, C 3 H 8 3 or C 3 H 5 30H. It is a tri-atomic alcohol 
of the third series of hydrocarbons, of which the first member 
is C 3 H 8 , or propane. When three hydrogen atoms of propane 
are replaced by three hydroxyl radicals, glycerin results. 
Glycerin may be obtained by passing super-heated steam 
through fats, which brings about a separation of the fat into 
glycerin and a fat acid. Glycerin also results in soap making. 

Explain the difference between a galvanic and a faradic 
current. 

A galvanic current results from chemical action, and has 
but low potential with large quantity. Its direction of flow 
is always the same. A faradic current results from induction 
of a current into a coil of insulated wire that surrounds a 



CHEMISTRY. 481 

shorter coil of larger wire, through which a galvanic current 
alternately flows, or is cut off from flowing. Such a faradic 
current possesses high potential, small quantity, and its 
direction of flow is to and fro, or alternating. 

What products of phenol are of interest in medicine? 

From phenol (carbolic acid, C 6 H 5 OH) we have coal tar 
creosote, the sulpho-carbolates, as of sodium, zinc, etc. 
Phenol-sulphonic acid, salol. 
Designate the following as chemical or physical changes: 

(a) The souring of milk. 

(b) Decomposition of sunlight by means of prisms. 

(c) Converting water into steam. 

(d) Dissolving salt in water. 

(e) Decay of wood. 

(a) Chemical; (b) physical change; (c) physical; (d) 
physical; (e) chemical. 

Mention the chief properties of nitrogen. 

In its molecular form nitrogen is a very inert substance. 
Its properties are negative ones; thus it will not burn, will 
not support combustion, has no color, odor or taste. It is 
slightly lighter than air. Symbol, N. Atomic weight, 14. 
It will unite directly with heated magnesium. It may enter 
into chemical union under favoring conditions with hydrogen, 
with oxygen, and with a few other of the non-metals. 

When nitrogen is in combination with other elements its 
atom gives great activity to the compounds. Thus it forms 
with hydrogen a very strong alkaline gas; with C, H and 0, 
nitrogen gives rise to extremely poisonous bodies— the alka- 
loids — to highly explosive bodies, as gun cotton; to food ele- 
ments of great nutritive value, the proteids, etc. 

What metal is liquid at ordinary temperature? 
Mercury. 

Mention a substance containing albumen, (a) as a liquid, 
(b) as a solid. 

(a) Milk, (b) Flour. 
31 



482 CHEMISTRY. 

What is the chemical cause of spontaneous combustion? 

May be active oxidation, as would occur were finely divided 
phosphorus exposed to air (oxygen). 

May be from direct chemical union of an intense activity, 
as would take place were phosphorus brought in contact with 
iodin or bromin. 

It may be due to dehydration of substances, as by the 
action of stroug sulfuric acid on wood or paper, or through 
the action of quicklime combining with moisture. 

Describe a test for the presence of organic matter in 
water. 

Having distilled water until free from ammonia, we add to 
the residue in the retort an acid solution of permanganate of 
potassium, when if, on again distilling, ammonia appears in 
the distillate, it would indicate the presence of organic matter 
in the water that had undergone conversion into ammonia 
through the action of the permanganate solution. 

This ammonia in the distillate may be recognized by the 
use of Nessler's solution. 

What is the specific gravity of normal urine? 

From 1015 to 1025. 

Give the names and formulas of five acids used in medU 
cine. 

Nitric acid, HN0 3 ; sulfuric acid, H 2 S0 4 ; muriatic acid, 
HC1; ortho-phosphoric acid, H 3 P0 4 ; acetic acid, HC 2 H 3 2 . 

Mention the elements existing uncombined in nature. 

Hydrogen, oxygen, nitrogen, carbon, sulfur, gold, silver, 
platinum, copper, mercury, and a few other metals. 

What is carbon dioxid? Give its formula, properties, 
uses and mode of production. 

It is a gas without color, odor or taste, being about one and 
a half times the weight of air. It does not support combus- 
tion nor animal respiration. It will not burn, it is soluble 



CHEMISTRY. 483 

in water. It may be liquefied and solidified. The liquid 
allowed to evaporate occasions very low temperatures in sur- 
rounding objects. Its formula is C0 2 . It is often held in 
water under pressure, and on the pressure being relieved the 
carbon dioxid gas escapes through the liquid, producing bub- 
bling (effervescence). 

We find this to constitute the ordinary soda water. Dis- 
solved in water, carbon dioxid adds piquancy to the taste of 
water, and it exerts a sedative effect upon an irritated or 
inflamed mucous lining of the stomach. Its presence in water 
increases the solvent power of water. 

It can be prepared through the action of an acid, as sulfuric 
acid, upon a carbonate, as marble dust. 

CaC0 3 + H 2 S0 4 = CaS0 4 + H 2 + C0 2 . 

When and why is a flame produced by combustion? 

"When in the gas we have present solid matter in a finely 
divided form. 

The heat of the flame rendering this solid matter incan- 
descent, gives rise to flame. 

Give the preparation of Fowler's solution, and describe 
the salts contained in it. 

Dissolve one part arsenious anhydrid and two parts potas- 
sium bi-carbonate in 94 parts water and add three parts 
compound tincture of lavender. 

The solution so made contains potassium met-arsenite. 

As 2 3 + 2KHC0 3 = 2KAs0 2 + H 2 + 2C0 2 . (Simon.) 

What is chloroform, and how is it made? 

It is the tri-chlorid of methane, CHC1 3 . 

It is a colorless liquid, specific gravity of 1.5; it has a char- 
acteristic aromatic odor and a sweet burning taste. It is 
capable of producing general anesthesia when inhaled. It is 
a valuable solvent for a number of substances, as alkaloids, 
rubber, etc. It is made by distilling the bleaching salt of 
lime with alcohol and purifying the result. 



484 CHEMISTRY. 

Describe glucose, and state its importance in medical 
chemistry. 

Glucose, C 6 H 12 6 , is a sweet solid substance often used in 
place of sugar. 

It causes right polarization, and will reduce cupric hydrate 
to the red sub-oxid of copper, thus differing from cane sugar. 
It is soluble in water. It results in animal digestion through 
the action of digestive ferments, ptyalin and amylopsin upon 
starch. 

In the urine, should glucose appear, it indicates the exist- 
ence of the disease diabetes mellitus. 

Give the chemical name for (a) tartar emetic, (b) cream 
of tartar, (c) sugar of lead, (d) copperas, (e) Rochelle 
salts. 

(a) Potassic antimonyl tartrate, KSbOC 4 H 4 6 , (b) Po- 
tassic hydric tartrate, KHC 4 H 4 6 . (c) Plumbic acetate, 
Pb2C 2 H 3 2 . (d) Ferrous sulfate, FeS0 4 . (e) Potassic so- 
dic tartrate, KNaC 4 H 4 6 . 

Describe and illustrate alcoholic fermentation. 

Alcoholic fermentation is the decomposition of sugary 
liquids brought about through the presence of a ferment, 
the yeast plant, and attended by the change of glucose into 
alcohol and carbonic oxid gas. 

C 6 H 12 6 = 2C0 2 + 2C 2 H 5 OH. 

What is ethyl hydrate? Give its formula, and state 
how it is produced. 

Ethyl hydrate, C 2 H 5 OH, is ordinary grain alcohol. It 
results from fermentation of sugary liquids, and is separated 
from water and other matters by subsequent distillation. 

Complete the following equations: 

2NaCl + Ag 2 S0 4 = 

Ba0 2 + C0 2 + H 2 = 

2NaCl + Ag 2 S0 4 = 2AgCl + Na 2 S0 4 

Argentic chlorid + Sodic sulfate. 

Ba0 2 + C0 2 + H 2 = BaC0 3 + H 2 2 

Baric ,. Hydric 
carbonate "^ peroxid. 



CHEMISTRY. 485 

Define matter, amorphous state, malleability. 

Matter refers to anything that has weight and occupies 
space. 

Amorphous state is applied to a solid substance not occur- 
ring in crystalline form. 

Malleability is the property by virtue of which a substance 
may be hammered or rolled out into thin sheets. 

Define and illustrate osmose. 

Osmose refers to the intermingling or mixing of liquids of 
different densities when separated by porous partitions; thus 
if a cupric sulfate solution be placed in a jar of porous 
earthenware, and this jar be set in a larger vessel containing 
distilled water, we would soon find sulfate of copper present 
in the outer jar that contained water, while the jar contain- 
ing sulfate of copper would be weakened through the passing 
inward from the outer vessel of distilled water. 

Give an illustration of decomposition by (a) heat, (b) 
electricity, (c) light. 

(a) Heat mercuric oxid, and we have it decomposed into 
the gas oxygen and the metal mercury. 

(b) Pass galvanic current through water, when it will 
undergo decomposition, and hydrogen and oxygen gases will 
be set free. 

(c) Expose argentic chlorid to the action of sunlight, when 
it undergoes decomposition, producing a sub-chlorid of silver, 
and changing in color from white to black. 

What is a compound radical? Give three examples of 
compound radicals, indicating the valence of each. 

A compound radical is a chemical combination of two or 
more atoms, and is capable of playing the part of an elemen- 
tary substance ; or a compound radical is an unsatisfied group 
of atoms. 

Examples : N0 3 , valence 1 ; S0 4 , valence 2 ; P0 4 , valence 3. 



486 CHEMISTRY. 

Describe the medicinal uses of oxygen, stating how it is 
brought to the bedside and how it is applied. 

Oxygen gas subjected to pressure is liquefied and stored in 
cast steel cylinders, which though of relatively small size and 
easily transported will yield 40 gallons of the gas. These 
cylinders have adapted to them a peculiar valve that admits 
of the escape of but a minute quantity of the liquid 'oxygen, 
favoring its immediate change to the gaseous state. The 
gaseous oxygen is conducted into a rubber bag, and from the 
bag through a wash bottle containing a small quantity of 
water, and the patient then inhales the gas from a proper 
mouth or nose piece. In the use of oxygen wo secure its flow 
by allowing the bag to fill with the gas and then compressing 
the bag. Oxygen is indicated wherever during disease respi- 
ration is embarrassed, as during the progress of pneumonia, 
asthma, etc. 

Oxygen is frequently used for its general stimulant effect. 

State the composition, mode of preparation and prop= 
erties of sal ammoniac. 

Sal ammoniac, ammonium chlorid, NH 4 CL is composed of 
one equivalent of the radical NH 4 and one equivalent of 
chlorin prepared by saturating hydrochloric acid with ammo- 
nia. It is a white crystalline soluble substance. It has a 
saline taste and neutral properties. It yields ammonia gas 
when heated with strong bases. It is used in medicine as an 
alterative and as a stimulating expectorant. 

What are the distinguishing characteristics of urates 
and of uric acid, as deposited in the urine? 

Uric acid and urates, as found in urine, are of yellow to 
red color; they form the "brick-dust" sediment. 

We find them appearing as the urine cools, and they at once 
dissolve on heating the urine. Under the microscope urates 
are of yellowish color, and in form they are acicular crystals 
or spherical masses with sharp needle-like projections. 

The addition of acid, like HC1, converts the urates into uric 



CHEMISTRY. 487 

acid, when the latter, being insoluble, they may be separated 
from urine. Then they are of lozenge form, rosette, and 
sometimes dumb-bell shape. 

Mention two substances that are fusible, two substances 
that are volatilized by heat, two substances that are un= 
affected by heat. 

Lead and iron are fusible. Iodin and sulfur volatilize. 
Carbon and silicon are unaffected by heat. 

Describe iron and its preparations. Why is iron pre- 
scribed in anemic conditions? 

Iron when pure is a gray- white metal, melts about 3000° 
Fahr., specific gravity about 7, is most tenacious of metals, is 
also ductile and malleable. 

It dissolves in sulfuric acid, in dilute nitric acid and in 
hydrochloric acid. 

It oxidizes in air in the presence of moisture. 

Preparations frequently used: Ferric chlorid, ferric sul- 
fate, ferric acetate, ferrous sulfate, ferrous carbonate, the 
hydrated sesquioxid of iron, the metal itself, organic salts of 
the metal, as the peptonate, albuminate, etc. 

Iron is prescribed in anemic conditions to afford a necessary 
element for the making of red blood corpuscles. 

What is organic chemistry? State the general prop= 
erties of organic compounds. 

Organic chemistry is the chemistry of the hydrocarbons 
and their derivatives. 

Organic compounds char when heated, and are finally en- 
tirely dissipated on continued heat. They occur in plants 
and animals. Their molecules, as a rule, contain but few 
elements, but often many atoms. 

Give illustrations differentiating combustion, fermenta= 
tion, putrefaction and decay. 

Heat wood strongly in air and it undergoes immediate 
change into carbon dioxid gas and water vapor and a residue, 



488 CHEMISTRY. 

called ash, of a mineral nature. This change, combustion, is 
accompanied by the evolution of light. Allow wood to re- 
main exposed to air and moisture for a lengthy period of time, 
when it slowly undergoes destructive change, yielding carbon 
dioxid gas, water vapor and a mineral ash. During this 
process of decay no light is evolved. 

Fermentation takes place only in such bodies as do not con- 
tain nitrogen. The process is initiated through the action of 
a ferment, and it yields alcohol and carbon dioxid gas. 

Putrefaction is the decomposition of substances that contain 
nitrogen, and is brought about through the presence of bac- 
teria, and constantly yields ammonia as one of its results. 

Explain the use of symbols and formulas. Give and 
translate five examples of each. 

A symbol is used as a representation of one atom of an 
elementary substance. A formula, an aggregation of sym- 
bols, represents one molecule of a substance. 

Oxygen, ; chlorin, CI ; bromin. Br ; nitrogen, N ; hydro- 
gen. H. 

HN0 3 , nitric acid; H 2 S0 4 . sulfuric acid; PbO, litharge; 
NH 3 , ammonia ; NaCl, sodium chlorid. 

What is the source of tartaric acid? What is its use in 
medicine? 

Argols, which are hard concretions found in wine casks, 
being deposited therein from fruit juices. 

Tartaric acid is used as a heat reducing agent. It is one 
of the ingredients of seidltz powder. Its salts are of use as 
laxatives. 

Explain the principle of the action of yeast. 

Under favoring conditions of proper temperature, presence 
of moisture, of air, the yeast plant causes, by its growth, 
such a rearrangement of the atoms of C, H and in glucose 
as to produce from one molecule of glucose two molecules of 
alcohol and two molecules of carbon dioxid gas. 



CHEMISTRY. 4S9 

How is an excess of urates determined in a sample of 
urine? 

Place urine to the depth of two inches in a test-tube of 
5 x 5 g size. Add 20 drops of strong HC1 and allow the mix- 
ture to stand 24 hours, at the end of which time the urates 
will have been converted into uric acid, and, normally, should 
yield a bulk of reddish sand-like sediment equal to half a 
wheat grain; should the deposit be greater it would indicate 
an excess of urates. 

What antidote should be employed in a case of strychnin 
poisoning? 

At once administer an emetic and tannic acid, then give 
potassic bromid in drachm doses, chloral hydrate in half 
drachm doses ; if convulsions arise use inhalation of ether or 
chloroform. Use rectal injections of chloral, etc. 

Define hydrid, specific heat, haloid salt, base. 

A hydrid is a binary compound containing hydrogen and 
one other element. 

By specific heat we mean the quantity of heat a given weight 
of a substance will contain compared with the quantity of heat 
a given weight of a substance taken as a standard will con- 
tain when both standard and other substance are heated at 
the same temperature. 

A haloid salt is one that exists in sea water, or it is salt 
containing a metal in combination with a member of the 
4-hlorin group. 

A base is an electro-positive substance. This term may refer 
to a metal or it may be applied to the oxid or hydrate of a 
metal. 

In what respect does sterilized milk differ from raw 
milk? 

The heat of sterilizing milk coagulates the lact-albumin. 
the globulin, and modifies the casein. On acidifying the ster- 
ilized milk all the proteids are precipitated at once in a firm 
curd that will not be digested. In sterilizing milk, germs 
that may be present will be killed. 



490 CHEMISTRY. 

Complete the following equations and write the name of 
each resulting compound under its formula: 

As 2 3 + 3H 2 S = 
H 2 S0 4 + NaN0 3 = 

As 2 3 + 3H 2 S = As 2 S 3 + 3H 2 

Arsenic sulfid -f- Water. 

H 2 S0 4 + NaN0 3 = NaHS0 4 + HNO s 

Sodium hydrogen sulphate -f- Nitric acid. 

Explain the chemistry of a candle flame. 

Candle flame shows three distinct zones, inner one consist- 
ing of vaporized hydrocarbons. Gives no illumination and 
scarcely any heat. Middle flame the illuminating flame. 
Consists of solid carbon in very fine subdivision, rendered 
incandescent by the heat due to the combination of oxygen of 
the air with hydrocarbon vapors. Gives a large amount of 
heat. Third or surrounding zone darker in color, contains 
solid particles of carbon, as soot, also carbon dioxid and vapor 
of water, as a result of the burning of the hydrocarbon vapors. 
Supplies but little heat and scarcely any light. 

Write the chemical name and formula for laughing gas* 

Nitrous oxid, nitrogen monoxid, hyponitrous oxid. N 2 0. 

What is the chemical change which occurs in the making 
of malt? 

Starch is changed to maltose, C 12 R 22 11l , a variety of sugar, 
through the absorption and chemical union with water. 
Maltose consists of two starch molecules chemically combined 
with a molecule of water. 

Explain how water containing organic impurities may 
become purified by running in a shallow stream or over a 
precipice. 

This enables all parts of the water and its contained im- 
purities to be brought in contact with atmospheric oxygen, 
when the organic matter is oxidized, decomposed and forms 
harmless bodies. 



CHEMISTRY. 491 

What is ammonium? 

Ammonium is a hypothetical electro-positive base, its for- 
mula NH 4 . In this form it passes in chemical change from 
union with one substance to another substance. 

It has never been isolated, but its components in the given 
proportion can be recovered from salts of ammonium. 

Mention a test of C0 2 , and also its chief properties. 

"When passed into clear lime-water it producces a white 
precipitate of calcium carbonate, or chalk, and on adding an 
excess of carbon dioxid this precipitate will dissolve, or this 
precipitate dissolves upon the addition of any acid. Carbon 
dioxid is a heavy gas about 1% times the weight of air, not a 
supporter of combustion nor of respiration. It will not burn ; 
can be liquefied and solidified. 

What elements enter into the composition of all alka= 
loids? 

Carbon, hydrogen, nitrogen, in volatile alkaloids. Carbon, 
hydrogen, nitrogen and oxygen, in fixed alkaloids. 

Explain an experiment to prove that chemical action 
may be induced by light. 

The sun's rays or diffused daylight will bring about chem- 
ical union between hydrogen and chlorin to form hydrochloric 
acid, this union accompanied by explosive violence, so mix 
equal volumes of hydrogen and chlorin in a glass jar; place 
in the path of sun's rays. 

From what source is acetic acid derived? Mention its 
most common and its purest form. 

From distillation of soured, weak alcoholic liquids, as cider, 
or from destructive distillation of wood, the formation of an 
aluminum acetate through treatment of the distillate, and 
then decomposition of this aluminum salt by sulfuric acid. 

Vinegar is a very common form of dilute acetic acid. Gla- 
cial acetic acid, about 99 per cent, strong, solid at 60° Fahr., 
is a pure form. 



492 CHEMISTRY. 

What is the technical name of (a) aqua regia, (b) aqua 
fortis, (c) oil of vitriol? 

(a) Nitro-hydrochloric acid; (b) nitric acid; (c) sulfuric 
acid. 

What is iodoform? What is its chemical formula? 

It is the tri-iodid of methane, an organic substitution com- 
pound, in which three atoms of hydrogen in methane are 
replaced by three iodin atoms. Its formula is CHI 3 . 

Describe the properties of hydrogen, and mention a test 
to prove that it will not support combustion. 

It is a colorless, tasteless, odorless gas, lightest of the well 
known elementary gases; burns in air or oxygen; will not 
support combustion nor animal respiration. May be lique- 
fied and (perhaps) solidified. Is strongly electro-positive, 
and is often grouped among the metals. A proof that it does 
not support combustion is afforded when on plunging a 
lighted taper into a jar of hydrogen, held mouth downward, the 
flame of the taper is extinguished, although the hydrogen 
may burn at the mouth of the jar. 

Give the composition of aqua ammonia. 

Aqua ammonia, NH 4 OH, known as ammonium hydrate or 
ammonium hydroxid, is composed of one molecule of ammonia 
gas, NH 3 , dissolved in and chemically combined with one 
molecule of water. It is thought that the radical NH 4 , formed 
through the union of NH 3 with one of the hydrogen atoms of 
water, enters into chemical union with the radical OH, left 
from the removal of one of the hydrogen atoms of water. 

What chemical change takes place in the air when in- 
haled? 

After being inhaled, air loses a large proportion of oxygen 
and gains a large proportion of carbon dioxid, with ammonia, 
vapor of water and organic impurities, all resulting from the 
oxidation of animal tissues. 



CHEMISTRY. 493 

What is meant by (a) hard water, (b) soft water? 

(a) A water containing dissolved in it an excessive quan- 
tity of mineral salts; (b) a water comparatively free from 
dissolved salts. 

What is peroxid of hydrogen? 

Peroxid of hydrogen, H 2 2 , in its purest form, is a syrupy 
liquid. 

It is usually found in commerce in watery solutions contain- 
ing 12 to 14 volumes of a gaseous peroxid of hydrogen. Such 
liquids are colorless, odorless and tasteless, have strong bleach- 
ing, disinfectant and oxidizing properties. 

Which of the metals is the best conductor of electricity? 

Silver. 

Account for the poisonous property of illuminating gas. 

Chiefly due to the presence of carbon monoxid, but also 
arising through the action of C0 2 , C 2 H 2 , CH 2 and sulfid gases. 

What is the normal reaction of (a) saliva, (b) bile? 
What causes the reaction? 

(a) Alkaline, owing to the presence of bi-carbonates and 
phosphates of the alkalies; (b) alkaline, from the presence of 
sodium salts of organic acids. 

Give formula for (a) mercuric chlorid, (b) sodic sulfate, 
(c) potassium chlorate, (d) cupric nitrate, (e) calcium 
carbonate. 

(a) HgCl 2 ; (b) Na 2 S0 4 ; (c) KC10 3 ; (d) Cu(N0 3 ) 2 ; (e) > 
CaC0 3 . 

What is the source of (a) citric acid, (b) acetic acid, (c) 
carbolic acid? 

(a) Lemon juice; (b) oxidation of alcohol or distillation of 
wood; (c) coal tar or distillation of wood. 

Define saturation. 

Saturation, when applied to a liquid, would mean that the 
liquid held dissolved all of a solid or gaseous body that it was 



494 CHEMISTRY. 

capable of dissolving; we may use the term saturation with 
like meaning in speaking of the solvent powers of gases or 
vapors for other gases or vapors. 

Discuss the value of sulfur as a germicide. 

Sulfur will only act as a germicide when combined with 
oxygen to form sulfur dioxid. 

In its germicidal action, the sulfur dioxid extracts moisture 
from the germ with which it enters into chemical union to 
form sulfurous acid. It then takes to itself from the germ 
an additional atom of oxygen, to again change to sulfuric 
acid, so that we may say in its germicidal action it dehydrates 
and then deoxidizes. 

The action of sulfur dioxid, it must be remembered, is also 
that of a bleaching agent, so that care must be taken to re- 
move fabrics of any value that have color from the room, or 
the action of the gas will take away their color. 

By what forces can (a) a solid be changed into a liquid 
or a gas, (b) a gas be changed into a liquid or a solid? 

(a) By heat or by lessened pressure; (b) by applying cold 
or by increasing pressure. 

Under exceptional conditions very great increase of motion 
may change a solid to liquid or liquid to gas, while conversely 
conditions approaching a state of rest may have a contrary 
effect. 

What is the composition of baking powders? How are 
they adulterated? What is their mode of action? 

They all contain sodium bi-carbonate mixed with an acid 
salt or a weak acid, as potassium bi-tartrate, an acid salt. 

They act through liberating C0 2 gas, as 
KHC 4 H 4 O c + NaHC0 3 = KNaC 4 H 4 6 + H 2 + C0 2 . 

Alum is an injurious adulterant; flour, chalk or gypsum 
may be used as adulterants to give bulk. 

What are peptones? What is turpentine? 

Peptones are crystallizable, dialyzable, nitrogenous, organic 
formative materials. They are the result of the conversion 



CHEMISTRY. 495 

of proteid foods in assimilable form through the action of 
digestive ferments, principally pepsin. 

Turpentine, C 10 H 16 , an essential oil, is a hydrocarbon ob- 
tained from the sap of pine trees. 

State the properties and uses of H 2 S0 4 . 

It is the most corrosive of the mineral acids, exhibiting an 
intense desire to combine with moisture. 

It is a bi-basic acid, and capable of forming two classes of 
salt. It has the properties that distinguish acids in general. 
In its use we find it the most important of all known manu- 
factured substances. No civilized industry could exist with- 
out making use directly or indirectly of this acid. 

It is also of great use in the scientific pursuits. 

How does diet affect the elimination of urea? 

A nitrogenous diet tends to increase the elimination of urea. 

A restricted diet, starvation, or a non-nitrogenous diet 
diminishes the elimination of urea. 

Disease accompanied by rapid or long continued tissue 
changes, as during high fevers, may be accompanied by in- 
creased elimination of urea even in the absence of a nitro- 
genous diet. 

Give the general definition and description of albumi* 
noids. 

They form a group of proteids that act somewhat differ- 
ently from simple proteids. They occur chiefly as constituents 
of the skeleton, skin and its appendages. As a rule they 
exist in an insoluble condition, not reacting as do ordinary 
proteids to the usual solvents and reagents. 

They include kreatins, elastin, collagen, gelatin and others. 

Complete the following equations and write the name 
of each resulting compound under its formula: 
CoH r ,Cl + AgHO = 
Sb„S 3 + 6HC1 = 
C 2 H 5 C1 + AgHO = C 2 H 5 OH + AgCl 

Ethyl alcohol + Argentic chlorid. 

Sb 2 S 3 + 6HC1 = 2SbCl 3 + 3H 2 S 

Antimony tri-chlorid + Hydrogen sulfid 



496 CHEMISTRY. 

Express the equivalents of one litre and one meter in 
units of another system, and express the equivalent of one 
gram in units of troy weight. 

One litre equals 33.8 ounces ; one meter equals 39.37 inches ; 
one gram equals 15.432 troy grains. 

What are bromids, iodids, chlorids? 

Bromids are binary bodies composed of bromin and a. basic 
element or radical. Chlorids are binary bodies, one of the 
elements of which is chlorin. Iodids are binary bodies con- 
taining iodin in chemical union with an electro-positive ele- 
ment or radical, or, as in the case of bromids or chlorids, a 
substance less electro-negative than the halogen element. 

Write the formula of (a) sulfurous acid, (b) acetic acid, 
(c) hydrochloric acid, (d) water, (e) cupric sulphate. 

(a) H 2 S0 3 ; (b) C 2 H 4 2 ; (c) HC1; (d) H 2 0; (e) CuS0 4 . 

What are mineral waters? 

Mineral waters are such waters as contain too great a quan- 
tity of dissolved mineral salts to warrant their use for ordi- 
nary drinking purposes; they usually contain more than 125 
grains of dissolved mineral salts in the gallon. 

They possess various medicinal virtues in accordance with 
the particular kinds of mineral salts they contain. 

Give the composition of water by volume and by weight. 

Water in the form of vapor is composed of two volumes of 
hydrogen and one volume of oxygen, which having entered 
into chemical union is condensed to measure but two volumes. 

Water is composed of two parts by weight of hydrogen in 
chemical union with 16 parts by weight of oxygen. 

Give test for the presence of sulfuric acid in vinegar. 

To vinegar add a few drops of a solution of barium nitrate, 
when should sulfuric acid be present there will form a white 
precipitate that will prove insoluble in acids. 



CHEMISTRY. 497 

How may the presence of arsenic in wall paper be de= 
tected? 

Since arsenical color is usually that of an arsenite of copper, 
the presence of arsenic in the color of a wall paper would be 
indicated if on touching the wall paper with a drop of ammo- 
nium hydroxid an ultra-marine blue color developed at the 
wetted spot. 

This is not absolutely proof of the presence of arsenic. 

Complete the foiiowing equation: 

CaC0 3 + 2HCl = 

CaC0 3 + 2HC1= CaCl 2 + H 2 + C0 2 . 
What chemical changes take place in decaying bodies? 

A production of H 2 0, NH 3 and C0 2 , with, of course, many 
additional gaseous bodies from the presence of certain ele- 
ments. Thus if sulfur be present H 2 S or (NH 4 ) 2 S will be 
given off ; if phosphorus be present PH 3 will form, etc. 

What is the antidote for poisoning from hydrocyanic 
acid? 

A solution of mixed ferrous and ferric sulfates with sodium 
or potassium hydroxid or carbonate added. Also use ammo- 
nia by inhalation, artificial respiration, f aradism to the heart. 

What antidotes should be used in phosphorus poisoning? 
Why? 

Copper sulfate in solution. Acts antidotally to phosphorus 
through producing a metallic coat covering particles of phos- 
phorus. This is due to the reducing action of phosphorus 
upon metallic salts when in solution. 

Old French ozonized oil of turpentine, an antidote to phos- 
phorus, through promoting such change (oxidation) of the 
phosphorus as results in the formation of substances compar- 
atively free from poisonous action. 

What is the source of tartaric acid? What double salts 
of this acid are used in medicine? 

Argols. Found in wine casks, deposited therein from grape 
juice. 

32 



498 CHEMISTRY. 

Double tartrates of potassium and sodium, called Rochelle 
salts. 

Double tartrates of potassium and antimonyl (SbO), form- 
ing tartar emetic. 

Double tartrate of potassium and hydrogen, or acid potas- 
sium tartrate. 

Mention five common vegetable poisons, and state the 
antidote for one of them. 

Opium, belladonna, aconite, digitalis, nux vomica. 
Antidote to opium, permanganate of potassium, atropin, 
caffein. 

Describe the preparation of hydrogen dioxid, writing 
the reaction. Give uses of hydrogen dioxid. 

Mix peroxid of barium with water, pass C0 2 gas through 
the mixture, filter, concentrate the nitrate by evaporation in 
vacuum over strong sulfuric acid. Ba0 2 + H 2 C0 3 = BaC0 3 
+ H 2 2 . Uses : For bleaching, disinfection ; it is a strong 
oxidizing agent, the restoring of oil paintings. 

Complete the following equations: 

CuS0 4 + 2KOH = 

NaHC0 3 + HCl=: 

CuS0 4 + 2KOH = Cu(0H) 2 + K 2 S0 4 . 

NaHC0 3 + HC1 = NaCl + H 2 + C0 2 . 

Describe an electric battery, and explain the operation 
of the chemicals used. 

A battery made up (for example) of six cells, each cell 
consisting of a glass jar filled with a solution of potassium 
bichromate, sulfuric acid and water, and immersed in this 
liquid a strip of zinc between two strips of carbon. 

The zinc in contact with the acid of the fluid forms sulfate 
of zinc, which dissolves in the liquid present, and hydrogen 
gas, which latter at once combines with the bichromate of 
potassium to reduce it to chromic acid. 

The galvanic electric current passes from the metal most 
active chemically (the zinc) through the fluid to the metal or 



CHEMISTRY. 499 

substance least active (the carbon). Wires attached to the 
carbon and passing from the battery cell carry the electric 
current, and these wires may be attached to the zinc of a 
second cell, and so the cells are connected in tandem. 

Finally, the wire from the carbon of the last cell leaving 
the battery will be known as the positive electrode, and should 
a continuous pathway be provided back to the zinc of the first 
cell such wire attached to the zinc would be known as the 
negative electrode. 

Give the sources and uses of ammonia in medicine and 
in the arts. 

Ammonia is now obtained from the room in which illumi- 
nating gas is washed with water, these washings containing 
ammonium hydrate. 

Ammonia, the gas, may be obtained by heating a salt of 
ammonium with a strong base. 

Ammonia is used in medicine as a cardiac and a general, 
quickly-acting stimulant. In the arts it is used as a volatile 
base, as a cleansing, detergent substance, as an ant-acid. 

Show by equation how nitric acid is formed by the action 
of sulfuric acid on potassium nitrate. How is nitric acid 
distinguished from the other mineral acids? 

KN0 3 + H 2 S0 4 == HNO3 + KHS0 4 . 

Nitric acid turns a fragment of wood to a red or orange 
color. Hydrochloric acid yields to wood a lemon-yellow color. 
Sulfuric acid turns wood dark brown or black. 

Nitric acid in contact with metal copper yields a greenish- 
blue liquid, and gives rise to orange-red fumes of N 2 4 , this 
action not being brought about by any other of the mineral 
acids. 

Indicate by chemical signs and symbols the reactions 
that occur when (a) a phosphorus match is lighted in the 
air, (b) sodium is placed on the surface of the water, (c) 



500 CHEMISTRY. 

hydrochloric acid is poured on marble, (d) two portions of 
seidlitz powder are mixed in water. 

(a) P 4 + air(50 2 )=2P 2 5 . 

(b) Na 2 + H 2 = Na 2 + H 2 ; then Na 2 + H 2 = 2NaHO. 

(c) 2HC1 + CaC0 3 = CaCl 2 + H 2 + C0 2 . 

(d) KNaC 4 H 4 6 + NaHC0 3 + H 2 C 4 H 4 6 = 

KNaC 4 H 4 6 + NaHC 4 H 4 6 + H 2 + C0 2 . 

Describe the chemistry of alcohols and ethers. 

An alcohol is a water in which one hydrogen atom in each 
molecule of water has been replaced by an alcohol radical; 
or an alcohol is a hydrate of an alcohol radical. 

An ether is a water in which both hydrogen atoms of a mole- 
cule of water have been replaced by alcohol radicals; or an 
ether is the oxid of an alcohol radical. 

What treatment is indicated in a case of poisoning by 
mercuric chlorid? 

Administer the albumen of eggs, if possible ; if these be not 
at hand give some form of albumen, as milk, flour, etc. 

Then use stomach pump, syphon tube or emetic, so as to 
at once remove the newly formed albuminate of mercury in 
stomach. 

Explain the constitution of the fats and the process of 
saponification. 

A fat is a chemical union of glycerin with a fat acid. 
If a base, such as caustic potash, be boiled with a fat, the 
glycerin is separated from the fat acid, the latter then com- 
bining with the base to form a salt. This salt is a soap. 

To facilitate the rise of the soap, salt is added in the process 
of soap making. 

Complete the following equations: 
AgNO s + NaCl = 
Si0 2 + HF = 

AgN0 3 + NaCl = AgCl + NaN0 3 . 
Si0 2 + 4HF = SiF 4 + 2H 2 0. 



CHEMISTRY. 501 

Give equation showing a mode of preparation of CH 4 . 

C 6 H 10 O 5 (wood fibre) + air (OJ = 2CH 4 + 4C0 2 + H 2 0. 

Find the weight and the volume of hydrogen contained 
in 17 grams of NH 3 . 

Seventeen grams of NH 3 will yield 3 grams of hydrogen 
measuring 33.48 litres. 

What is sulfuretted hydrogen? Give its formula, prop- 
erty and uses. 

It is a colorless gas, slightly heavier than air, of offensive 
odor and poisonous action. It is soluble in water, and burns 
in air with a blue flame to form sulfur dioxid and water. It 
is used as an antagonist to chlorin. It is used as a group 
reagent, precipitating a number of metals in the form of 
insoluble sulfids. Its formula is H 2 S. 

Name and give the formulas of three important salts of 
potassium used in medicine. 

Potassium acetate, KC 2 H 3 2 . 
Potassium nitrate, KN0 3 . 
Potassium chlorate, KC10 3 . 

What is methylic alcohol? What are its properties and 
uses? 

Methylic or wood alcohol, CH 3 OH, is obtained as a product 
of the destructive distillation of wood. It is a light, colorless 
liquid, with a characteristic offensive odor. 

It is poisonous, and this, with its offensive odor, unfits it 
for use in fortifying alcoholic beverages. It has a large use 
in the arts as a solvent for resinous and gum-like substances, 
as in the making of varnishes. It is used for the obtaining 
of heat through its burning. 

From what oil may salicylic acid be obtained? Give its 
properties. 

From oil of gaultheria or wintergreen. Salicylic acid, 
HC-H 5 3 , is a white, solid, odorless substance, having a sweet- 
ish, slightly acrid taste. It has an acid reaction, and is spar- 



502 CHEMISTRY. 

ingly soluble in cold water, freely soluble in alcohol and in 
ether. It is a valuable antiseptic and anti-rheumatic remedy. 

Defend the statement, " Matter is indestructible." 

That matter is indestructible may be illustrated by the 
burning of a candle, where, although the candle loses in weight 
from the consumption of its wax, yet if care be taken to save 
and weigh the results of the combustion of the wax and the 
products formed through the union of oxygen with the carbon 
and hydrogen composing the wax, and the weight of oxygen 
obtained from the air be deducted, the resultant will corres- 
pond in weight with the weight the candle has lost in burning. 

Explain and illustrate the law of chemical combination 
by volume. 

Law of Gay-Lussac : When two or more gaseous constituents 
combine chemically to form a gaseous compound the volumes 
of the individual constituents bear a simple relation to the 
volume of the product. Thus one volume of hydrogen com- 
bines with one volume of chlorin to form two volumes of 
hydrochloric acid. Again, three volumes of hydrogen com- 
bine with one volume of nitrogen to form two volumes of 
ammonia. 

Give the history, occurrence in nature and preparation 
of oxygen. 

Attention was first called to the existence of oxygen by Dr. 
John Mayow, of England, in 1664. Oxygen was discovered by 
Dr. Joseph Priestley, of Birmingham, England, on August 1st, 
1774. It was given the name oxygen by Lavoisier, the 
French chemist, because he thought it rendered substances 
with which it combined acid, or was the cause of acidity of 
acids. 

It is found elementary in the air and dissolved in water. 
It is found in combination in oxids, acids, salts, hydrates, 
organic compounds. It may be prepared by heating a mixture 
of manganese dioxid and chlorate of potassium. 



CHEMISTRY. 503 

Give reasons from a chemical standpoint for the use of 
gold and silver for coin. 

They do not oxidize in air or water ; when properly alloyed 
they are not much subject to abrasion ; their degree of purity 
may be readily determined by reagents ; they do not commu- 
nicate an odor nor a poisonous effect when handled. 

Name three metals of the alkaline earth, giving a com= 
pound of each with its formula. 

Barium, barium chlorid, BaCl 2 . 
Strontium, strontium nitrate, Sr(N0 3 ) 2 . 
Calcium, calcium carbonate, CaC0 3 . 

What are the general characteristics of the metals of 
the iron group? 

When at a red heat they decompose water; their oxids, hy- 
drates, phosphates and carbonates are insoluble in water. 
They have relatively high fusing points, and are of consider- 
able tenacity, malleability and ductility. They are all pre- 
cipitated from their solutions, when alkaline, by hydrogen 
sulfid. 

What is coal=oil, and what are some of its principal pro= 
ducts used in the practice of medicine? 

Coal oil, or petroleum, is produced from decomposition of 
organic matter. It is a mixture of various liquid paraffins, 
containing gases and solid matters in solution. From coal oil 
we may obtain carbolic acid, salicylic acid, sulphonal, phe- 
nacetin, acetanilid. 

Complete the following equation and write the name of 
the resulting compounds: 

C 2 HC1 3 + KOH = 

C 2 HC1 3 + KOH = KCH0 2 + CHC1 3 

Potassic formate -}- Chloroform. 
Give the general properties of alkaloids. 

They are of three groups, vegetable, animal and synthetic 
alkaloids. They all contain nitrogen; they may be classed as 



504 CHEMISTRY. 

fixed alkaloids, which, in addition to C, H and N, contain 0, 
and the volatile alkaloids which contain no 0. 

The vegetable alkaloids (fixed) are crystalline solids but 
slightly soluble in water; all are basic in reaction, and they 
form salts by direct union with acids without displacing the 
hydrogen of the acid. As a rule they are very poisonous; 
they generally represent the active principle of the drug sub- 
stance. The volatile alkaloids, like nicotin, are liquid bodies. 

What is the percentage composition of NaN0 3 ? 

Atomic weight of Na is 23 ; of N, 14. 
Atomic weight of is 16 ; of 3 , 48. 
Sum of atomic weights 85 ; then 

85 : 100 :: 23 :X = sodium, 27. per cent. 

85 : 100:: 14 :X = nitrogen, 16.4 

85 : 100 :: 48 :X = oxygen, 56.6 



100.0 
Why is capillary attraction so called? Mention some 
familiar examples. 

Because this force is best observed in liquids enclosed in 
tubes the size of a hair (capilla). 

The passing of oil up the lamp wick. 

The flow of sap through vegetable fibre. 

The method of keeping moist the bulb of the wet-bulb ther- 
mometer. 

Define sterilization. 

Sterilization is the operation of removing that upon which 
germs depend for food for their existence. 

How does permanganate of potassium act as a disin- 
fectant? 

In contact with organic matter it undergoes decomposition, 
liberating its oxygen in a nascent form. 

Upon what theory are eggs given in cases of poisoning 
by corrosive mercury? 

That the albumen of the egg forms an insoluble albuminate 
of mercury. 



CHEMISTRY. 505 

Give the boiling point (Fahrenheit) of water, alcohol, 
of ether, of mercury. 

Water boils at 212° ; alcohol at 173° ; ether at 98.6° ; mer- 
cury at 680°. 

Give the names and formulas of four iodids commonly 
used in medicine. 

Mercuric iodid, or the red iodid of mercury, Hgl 2 ; potassic 
iodid, KI ; sodic iodid, Nal ; strontium iodid, Srl 2 . 

Give the formula for carbolic acid. How is it obtained, 
and what are its properties and uses? 

Carbolic acid, phenol, C 6 H 5 OH, obtained from destructive 
distillation of wood or of coal, as from coal tar. When pure 
is a crystalline solid with a characteristic odor, pungent and 
caustic taste, forms a white eschar on tissues. The crystals 
require an addition of but five per cent, of water to liquefy 
them ; if more water be added a turbid mixture results, which 
again becomes clear when 2000 parts of water have been added. 
Carbolic acid is soluble in 20 parts of water; glycerin favors 
its solution. It is used as an antiseptic, a disinfectant and a 
caustic. It has slight local anesthetic properties. 

Give the chemical meaning of the term sugar. 

Sugar is a general name applied to a class of carbohydrates 
which all possess sweetening powers. They are all more or 
less soluble in water, the most familiar of the group being 
saccharose obtained from the sugar cane. 

Give the comparative constituents of cows' milk and 
human milk as relating to water, fat, sugar, albuminoids. 

Cows' Milk. Human Milk. 

Water 84.28 87.24 

Fats 3.66 3.78 

Sugar and salts 5.62 5.78 

Albuminoids 3.76 2.88 

It will be seen that human milk contains more fats and less 
albuminoids, but a larger percentage of sugar than cows' milk. 



ANATOMY. 



Mention the sutures at the vertex of the skull and state 
what bones they unite. 

Sagittal suture, uniting the two parietal bones; lambdoid, 
uniting occipital with both parietals; coronal, uniting both 
parietals behind with frontal anteriorly. 

Mention and describe the salivary glands. 

Parotid, submaxillary, sublingual. Parotid, largest, placed 
in front of ear, behind ramus of mandible; duct (Steno's) 
passes across masseter muscle, perforates buccinator muscle, 
terminates in cheek wall opposite upper middle molar. Par- 
otid has facial nerve, external carotid artery, temporo-maxil- 
lary vein passing through it. 

Submaxillary gland is located upon inner side of body of 
mandible posteriorly, is crossed by facial artery; duct (Whar- 
ton's) passes forward, terminating close to fraenum linguae. 

Sublingual gland, located in shallow fossa upon inner side 
of body of mandible, near symphysis, is covered by mucous 
membrane of mouth; ducts (Bartholin's) terminate near 
fraenum linguae. 

Mention any one muscle which moves the humerus (a) 
forward, (b) backward, (c) inward. 

(a) Coraco-brachialis ; (b) posterior fibres of deltoid; (c) 
latissimus dor si. 

What would be the collateral circulation if the brachial 
artery were ligated below its profunda branches? 

Superior and inferior profunda above, anastomotica magna, 
radial and ulnar (anterior and posterior) recurrent below. 

(507) 



508 ANATOMY. 

Describe the Meibomian glands. 

Sebaceous glands embedded in posterior surface of tarsal 
plates of eyelids, consisting of single duct with closely at- 
tached acini, orifices of ducts terminating in single row of 
apertures along posterior lid-margin. 

Give location and a description of the tubercula quad= 
rigemina. 

Located upon upper surface of crura cerebri, just behind 
third ventricle and beneath posterior part of velum inter- 
positum; nates anterior to testes. They consist of gray mat- 
ter externally, white internally, and are connected with bra- 
chia of optic tracts. 

Describe the renal blood circulation. 

Arterial blood enters sinus through hilum by means of renal 
artery, branches of which pass between Malpighian pyramids 
to cortico-medullary junction, where they form transverse 
branches which send arterioles into cortical and medullary 
portions of kidney, forming glomeruli in the former, and 
plexuses around the uriniferous tubules in the latter. The 
veins collect the blood from these parts, form cortico-medul- 
lary branches and pass through medullary portion between 
pyramids, leaving kidney through sinus as renal vein. 

Mention the muscles attached to the great trochanter of 
the femur. 

Gluteus medius and minimus, pyriformis, obturator inter- 
nus, gemellus superior and inferior, obturator externus. 

Describe the portal system. 

Is made up of veins which drain the chylopoetic viscera 
(stomach, pancreas, large and small intestine) and the spleen; 
consists of the portal vein which carries the blood from the 
above organs into and through the liver, and which is made 
up of superior mesenteric and splenic veins, the latter receiv- 
ing the inferior mesenteric vein; the portal itself receives the 
gastric vein. 



ANATOMY. 509 

What arteries, muscles and nerves would be severed in 
a cross=section at the middle of the humerus? 

Brachial, superior and inferior profunda; biceps, triceps, 
insertions of deltoid and coraco-brachialis, origin of brachi- 
als anticus; musculocutaneous, internal cutaneous, median, 
ulnar, musculo-spiral. 

State origin, course, function and distribution of sixth 
cranial nerve. 

Superficial origin, from groove between medulla and pons; 
course, forward through cavernous sinus, exit from cranial 
cavity by sphenoidal fissure; distribution to external rectus 
of eye. 

Give the relations of the right kidney. 

Rests upon quadratus lumborum and psoas magnus muscles, 
is in contact with under surface of right lobe of liver, has 
duodenum and ascending colon in front. 

Describe the right ventricle of the heart. 

Is placed mostly upon anterior aspect of heart, does not 
extend to apex, is crescentic in cross-section, contains tricuspid 
valve, which guards right auriculo- ventricular opening, to 
left and front of which is conus arteriosus leading up to pul- 
monary orifice, which is guarded by pulmonary semilunar 
valves, contains columnar carneae, musculi papillares and 
chordae tendineaa. 

Describe endothelium. 

Irregular, flattened (squamous) cells, attached edge to edge, 
resting on basement membrane. 

Describe the external carotid artery. 

One of the two terminal branches of common carotid, given 
off at level of upper border of thyroid cartilage, extends up 
neck, passes into parotid gland, where it terminates by divid- 
ing into superficial temporal and internal maxillary arteries. 
Branches are, ascending pharyngeal, to lateral wall of 
pharynx; superior thyroid, to larynx and thyroii body; lin- 



510 ANATOMY. 

gual, to tongue ; facial, to superficial parts of face ; occipital, 
to post-cervical and occipital regions; posterior auricular, to 
external and middle ear; superficial temporal, to scalp; in- 
ternal maxillary, to deep parts of face and by middle menin- 
geal (through foramen spinosum of sphenoid), to inner skull 
wall and dura. 

What muscles form the calf of the leg? Describe any 
one of these muscles. 

Gastrocnemius and soleus. Gastrocnemius takes origin by 
two heads from internal and external condylar ridges of 
femur; these heads unite, join the soleus, thus forming the 
tendo Achillis, which is inserted into the posterior extremity 
of the os calcis. 

Describe the thyroid gland. 

It consists of right and left lobes connected by an isthmus 
across 2d, 3d and 4th rings of trachea; has a capsule and 
trabecular enclosing closed follicles, which contain colloid 
material. 

Give a comprehensive description of any one of the 
long bones of the body. 

The humerus possesses a shaft and two extremities. The 
upper end has a head which is hemispherical and articulates 
with glenoid cavity of scapula. Just below it is the anatom- 
ical neck, to which the capsule of the shoulder- joint is at- 
tached. Then come the greater and lesser tuberosities, serving 
for the attachment of muscles, while below them is the surgical 
neck. The bicipital groove and ridges extend downward 
between the two tuberosities, and also serve for the insertion 
of muscles. Upon the posterior surface of the shaft is the 
musculo-spiral groove. Rough impressions are found upon 
the outer and inner aspects of the shaft for the deltoid and 
coraco-brachialis muscles respectively. The lower end is ex- 
panded laterally, to receive the radius and ulna, and supports 
the outer and inner condyles. The articular surface is di- 
vided into a capitellum externally for the head of the radius, 



ANATOMY. 511 

and a trochlea internally for the greater sigmoid cavity of 
the ulna. Above the trochlear surface is the coronoid fossa 
anteriorly, and the olecranon fossa posteriorly. 

Into what two great classes are muscles divided? Give 
a macroscopic and a microscopic description of each. 

Voluntary and involuntary. The voluntary muscles num- 
ber about 311 in the body. The fibres are bound into bundles 
by connective tissue (perimysium), and are attached to bones, 
ligaments or integument by bands of white fibrous tissue 
called tendons. The involuntary muscular tissue is found 
throughout the greater part of the wall of the alimentary 
tract, in the walls of the arteries and veins, and in the uterus. 
The microscopic appearance of a voluntary fibre is one that 
is transversely striated, with a sarcolemma (sheath) inclosing 
the sarcous elements. The involuntary fibre is fusiform, is 
longitudinally striated, and possesses a centrally placed 
nucleus. 

Describe the right and the left subclavian vein. 

The right subclavian vein rests on the first rib in front of 
the scalenus anticus muscle, and is a continuation of the 
axillary vein; just below and behind the sterno- clavicular 
joint it unites with the internal jugular vein to form the right 
innominate vein. The left subclavian vein does not differ 
materially from the right; at the junction of subclavian and 
internal jugular on the left side the thoracic duct terminates. 
The subclavian veins receive the blood from the upper ex- 
tremities, shoulders, chest wall and superficial area of face 
and neck. 

Mention the flexor muscles of the forearm and describe 
one of them. 

Flexor carpi radialis, flexor carpi ulnaris, flexor sublimis 
digitorum, flexor profundus digitorum, flexor longus pollicis. 
Flexor profundus digitorum takes origin from upper % of 
shaft of ulna, from coronoid process and from interosseous 
membrane; is inserted by 4 tendons into last phalanx of each 
finger ; action, to flex last phalanx. 



512 ANATOMY. 

Compare aponeuroses with tendons. 

Aponeuroses are broad, flat sheets of fibrous tissue to which 
muscular fibres are attached, serving as tendons of insertion 
for these fibres. Tendons are rounded (cord-like) or narrow 
(ribbon-like) bundles of fibrous tissue attaching muscles to 
bones or forming ligaments of joints (shoulder, hip). 

Give the number of the cervical vertebrae and mention 
the marked characteristics of such of these vertebrae as 
are in any way pecculiar. 

Seven. The atlas is a ring with two lateral masses sup- 
porting a superior and an inferior pair of articular processes ; 
it has no spinous process; the axis has an odontoid process 
on the upper surface of its body ; the 7th vertebra has a long 
spine, hence its name, the vertebra prominens. 

Where may the Eustachian tube be entered and how 
may it be found? 

Eustachian tube may be entered from naso-pharynx ; its 
orifice is placed in lateral wall of pharynx just behind and 
slightly above floor of posterior nares. 

Name the bones of the head. 

Occipital, 2 parietals, frontal, 2 temporals, sphenoid, eth- 
moid, 2 nasal, 2 lachrymal, 2 inferior turbinals, vomer, 2 
maxilla?, 2 palate, 2 malar, mandible. 

Describe the acetabulum. 

Is formed by union of ilium, ischium and os pubis; has 
horse-shoe shaped articular surface and non-articular depres- 
sion at bottom ; cotyloid notch is below and in front ; is deep- 
ened by cotyloid ligament in recent state attached to rim. 

Name the seven muscles of the orbit. 

Levator palpebrse superioris, superior, inferior, external, 
internal recti, superior and inferior oblique. 

Where is the compressor urethrae muscle? 

Between the two layers of triangular ligament, and sur- 
rounds membranous urethra. 



ANATOMY. 513 

Describe the origin and distribution of the optic nerves. 

They arise from the optic commissure, pass out of cranial 
cavity with ophthalmic artery through optic foramen, pierce 
sclerotic and choroid, coats of eyeball to nasal side of posterior 
pole and are distributed to retinas. 

Name the processes of the dura mater. 

Falx cerebri, falx cerebelli, tentorium cerebelli. 

What is the solar plexus? 

A neuro-ganglionic collar of the sympathetic nervous system 
surrounding coeliac axis, from which nerve trunks accompany 
arterial branches to supply all abdominal viscera. 

Describe the vagina. 

Begins at vulvar aperture, extends upward and backward 
in axis of outlet of pelvis, surrounds cervix uteri, reaching 
higher up on cervix posteriorly than anteriorly, is lined with 
laminated squamous cells, has large venous plexuses in sub- 
mucosa, contains circular (within) and longitudinal (with- 
out) involuntary muscle fibres. Bladder and urethra are in 
front, rectum is behind. Peritoneum covers upper posterior 
wall. 

Differentiate synarthrosis, amphiarthrosis, and diarth- 
rosis, giving an example of each. 

Synarthrosis is an immovable joint consisting of two bones 
placed edge to edge with little or no fibrous tissue intervening ; 
example, lambdoid suture. Amphiarthrosis is joint permit- 
ting of slight motion, made up of two bones with intervening 
nbro-cartilaginous plate or disk and held together by liga- 
ments ; example, joints formed by bodies of vertebras and 
intervertebral disks. Diarthrosis is freely movable joint, 
consisting of two or more bones with articular surfaces cov- 
ered with hyaline cartilage and surrounded by ligaments lined 
with synovial membrane ; example, hip-joint. 

Describe the shouIder=joint. 

Variety, enarthrodial (ball-and-socket) ; bones, glenoid 
fossa of scapula, head of humerus; ligament, capsular, which 
33 



514 ANATOMY. 

is intimately blended with tendons of insertion of sub-scapu- 
laris, supraspinatus, infraspinatus and teres minor muscles; 
tendon of long head of biceps passes within capsule over 
humeral head, and is surrounded by synovial membrane ; 
movements, flexion, extension, abduction, adduction, rotation 
and circumduction. 

Give the origin, insertion, action and nerve supply of 
any one of the following muscles: superior oblique, mas= 
seter, trapezius. 

Trapezius, origin from external occipital protuberance, 
inner third of superior curved line of occipital bone, liga- 
mentum nuchae, spine of seventh cervical vertebra, spines of 
all thoracic vertebrae; insertion into posterior border, outer 
third of clavicle, inner margin of acromion and entire upper 
border of spine of scapula ; action, to retract head, to approxi- 
mate scapulae, to elevate point of shoulder, to assist serratus 
magnus in rotating scapula, as in act of carrying arm to up- 
right vertical position; nerves, spinal accessory, third and 
fourth cervical. 

Give the origin, main branches and relations of any 
one of the following arteries: external carotid, axillary, 
femoral. 

Axillary artery is continuation of subclavian from outer 
border of 1st rib, extends to lower border of axilla (teres 
major muscle) in line indicated by coraco-brachialis muscle 
(inner border), lying behind and above axillary vein; outer 
cord of brachial plexus is above it, inner cord is below it, 
posterior cord is behind it, median nerve lies upon it; pecto- 
ralis minor muscle crosses it in front, pectoralis major is ante- 
rior to first and third portions; branches are superior tho- 
racic, acromial thoracic, long thoracic, alar thoracic, sub- 
scapular, anterior and posterior circumflex. 

Describe the course of the nerve fibers in the optic 
commissure. 

Fibres upon its posterior surface (Gudden's commissure) 
have nothing to do with sight, and unite posterior quadri- 



ANATOMY. 515 

geminal bodies (testes) ; middle fibres decussate, those from 
right optic tract passing to left optic nerve and vice versa, 
to terminate in nasal half of retina; outermost fibres of each 
tract do not decussate, but pass into optic nerve to be dis- 
tributed to temporal half of retina of same side. 

Give the origin, course and distribution of the great 
sciatic nerve. 

Origin from lower lumbar and upper sacral nerves (sacral 
plexus) ; course, through great sacro-sciatic foramen below 
pyriformis muscle, from beneath lower margin of gluteus 
maximus midway between trochanter major and tuber ischii^ 
rests upon adductor magnus and divides about middle of thigh 
into internal and external popliteal nerves; it supplies semi- 
tendinosus, semimembranosus, adductor magnus and biceps. 
Internal popliteal is continued down leg as posterior tibial, 
distributed to back of leg and sole of foot; external popliteal 
curves around below head of fibula to front of leg, becoming 
anterior tibial to front of leg and dorsum of foot. 

Describe the great omentum. 

Made up of double fold of peritoneum, extending from 
greater curvature of stomach downward for variable distance, 
then returning, surrounds transverse colon. It contains be- 
tween its layers more or less adipose tissue. 

Give the gross and the topographic anatomy of the 
pancreas. 

The "abdominal salivary gland" is located in upper pos- 
terior part of abdomen, behind stomach, in front of vertebral 
column and left kidney, and to right of spleen. Is elongated, 
soft in consistency, made up of lobules held together by con- 
nective tissue, is pinkish in color, and is divided into tail, 
body and head, the latter embraced by curve of duodenum. 
Is supplied by branches from splenic artery, which courses 
along upper border. Its duct, extending throughout the 
length of the gland, terminates with common bile duct in 
descending portion of duodenum. 



516 ANATOMY. 

Locate and describe the pericardium. 

Fibro-serous sac surrounding heart, pyramidal, with base 
attached to central tendon of diaphragm, apex corresponding 
to great vessels at base of heart, and connected with deep 
cervical fascia by fibrous prolongations upward. Outer layer 
fibrous, lined with parietal serous layer, which is reflected 
upon heart and vessels at its base, constituting the visceral 
layer. 

Describe and give the anatomical relation of the ap= 
pendix vermiformis. 

Is Sy 2 to 4y 2 inches long, made up of inner mucous coat, 
which is thickly set with simple, tubular glands (crypts of 
Lieberkuhn) and covered with columnar epithelium, beneath 
which is a thick layer of adenoid tissue, diffused and collected 
into closed follicles; outside of mucous membrane is sub- 
mucosa, with plexuses of vessels and nerves; next comes 
muscular layer, having thick, inner circular and thinner, 
outer longitudinal layer; the peritoneum surrounds the ap- 
pendix and forms a meso-appendix, usually extending along 
one-half the length of the organ; in this the appendicular 
artery (branch of ileo-colic) courses; arterial supply is of the 
end-artery variety; the nerves are branches of the superior 
mesenteric plexus of the sympathetic system. The appendix 
is attached to the caecum, usually depending from its inner 
and posterior aspect, not far from ileo-caecal junction ; it may 
extend in any direction. In the female a fold of peritoneum 
is continued from the broad ligament to the meso-appendix 
( appendiculo-ovarian ligament), and conveys a branch of the 
ovarian artery. 

Describe Poupart's ligament, naming its anatomical re= 
lations and uses as a surgical guide. 

Is formed by aponeurosis of external oblique muscle blend- 
ing with fascia lata, and extends, slightly curved downward, 
from anterior superior iliac spine to pubic spine ; a reflected 
portion, Gimbernat's ligament, is attached to pubic end of 
iliopectineal line, forming inner margin of femoral (crural) 



ANATOMY. 517 

ring (neck of femoral hernia). Beneath Poupart's ligament 
external cutaneous nerve, ilio-psoas muscle, anterior crural 
nerve, femoral artery and vein are located; above and to 
outer side of pubic spine it forms outer pillar of external 
inguinal ring. 

Describe the femoral artery and its branches. 

Begins as continuation of external iliac beneath middle of 
Poupart's ligament, extends downward, bisecting Scarpa's 
triangle, through Hunter's canal, at lower end of which it 
becomes the popliteal. Branches are superficial epigastric, 
superficial circumflex iliac, superficial and deep external 
pudic, profunda, anastomotica magna, muscular. 

Name the principal lobes of the brain and the fissures 
dividing them. 

Frontal, parietal, temporal, occipital, central (island of 
Reil). Fissure of Rolando separates frontal from parietal; 
fissure of Silvius separates frontal and parietal from tem- 
poral; parieto-occipital fissure separates parietal from occip- 
ital ; central lobe is found deeply placed in Sylvian fissure. 

Name the twelve pairs of cranial nerves. 

Olfactory, optic, motor oculi, trochlear, trigeminal, abdu- 
cens, facial, auditory, glossopharyngeal, pneumogastric. spi- 
nal accessory, hypoglossal. 

Name the bones articulating with the humerus. 

Scapula, radius, ulna. 

Describe the Eustachian tubes. 

Two tubes connecting middle-ear with naso-pharynx. 
Pharyngeal orifice is usually vertical slit just above floor of 
nasal chamber, behind posterior naris, and bounded poste- 
riorly by "cushion" of pharynx. Tube is formed by tem- 
poral bone in angle between squamous and petrous portions, 
and by coiled plate of cartilage attached to edge of bony part 
of tube ; is lined with ciliated columnar epithelium. 



518 ANATOMY. 

Describe the diaphragm, its principal openings and 
nerve supply. 

Dome-shaped muscle, origin from inner surface of last six 
costal cartilages, posterior surface of ensiform cartilage, by 
two crura from bodies of lumbar vertebras (2d to 4th), from 
ligamenta arcuata, external and internal. Insertion into 
aponeurotic central tendon, which consists of three leaflets. 
Aortic opening is between crura, and transmits aorta, thoracic 
duct and vena azygos major; oesophageal opening is anterior 
and slightly to left of vertebral column, transmitting oeso- 
phagus and both pneumogastric nerves; caval opening is in 
right leaflet of central tendon, and to its margins the outer 
coat of inferior cava is attached. Nerve supply, both 
phrenics. 

Describe the broad ligaments of the uterus and their 
anatomical relations. 

Double folds of peritoneum attached to floor and lateral 
margins of true pelvis, covering uterus anteriorly and pos- 
teriorly, reflected from it to bladder in front and tc vagina 
behind. Between its layers are found Fallopian tubes, round 
ligaments, utero-ovarian ligaments, uterine and ovarian 
arteries and veins, lymphatics, and foetal relics. The ovaries 
are attached to it behind, near the pelvic brim. 

Describe the crystalline lens, and state what tissues are 
in contact with it, and how. 

Is a transparent, biconvex body, convexity being greater 
upon posterior surface than upon anterior; is contained in 
capsule, which is elastic; it consists of lens-fibres, which are 
derived from epithelial cells (ectoderm), arranged in layers 
which are of softer consistency near the surface (cortex), 
more compact and dense at the center (nucleus). It is non- 
vascular in the adult, its nutrition being maintained by inter- 
cellular transmission of nutritive fluids. Its suspensory lig- 
ament is formed by hyaloid membrane enclosing the vitreous, 
and is attached to lens capsule. The lens rests in patellar 
fossa of vitreous, iris (pupillary margin) rests upon its ante- 



ANATOMY. 519 

rior surface, and ciliary processes are in relation with its 
circular edge. 

Give a brief description of the membranes of the brain. 

The dura lines the cranial cavity, is adherent to the vault, 
sides and base, and sends processes between cerebral hemis- 
pheres (falx cerebri), between cerebrum and cerebellum 
(tentorium cerebelli), and between hemispheres of cerebellum 
(falx cerebelli) ; it splits to form spaces for the intima of 
veins, known as venous sinuses. The arachnoid, between dura 
and pia, is thin and delicate, and contains spaces for cerebro- 
spinal fluid, best developed at base of brain. The pia closely 
invests the encephalon, dipping into fissures and sulci, send- 
ing arterial branches into cerebral substance and receiving 
veins from same, and passes through transverse fissure into in- 
terior of brain, constituting velum interpositum, and furnish- 
ing choroid plexuses of ventricles. 

Describe the gross anatomy of the larynx. 

Consists of cartilaginous framework, ligaments, muscles, 
and is lined with mucous membrane. Cartilages are thyroid, 
cricoid, two arytenoids, two cornicula laryngis and epiglottis. 
Thyroid is shield-shaped, projects forward as pomum Adami ; 
cricoid is ring-shaped, is placed below thyroid, is broad pos- 
teriorly and supports arytenoids, one on each side of posterior 
quadrilateral portion. Epiglottis is attached by stem to angle 
of thyroid, and is directed upward over entrance to larynx. 
Crico-thyroid membrane extends from cricoid cartilage up- 
ward within thyroid, and by rounded, free edge forms true 
vocal bands, which extend between thyroid anteriorly and 
vocal processes of arytenoids posteriorly. Lateral crico- 
arytenoid muscles approximate vocal bands, posterior crico- 
arytenoir muscles separate them. Superior laryngeal artery 
pierces thyro-hyoid membrane to supply interior of larynx; 
superior laryngeal nerve is nerve of sensation to mucous 
membrane, and recurrent laryngeal is motor nerve to all mus- 
cles but one (crico-thyroid) supplied by superior laryngeal. 



520 ANATOMY. 

Minutely describe the relations of the peritoneum to 
the bladder. 

Covers upper surface and sides, reflected on to rectum in 
male and vagina in female; leaves anterior abdominal wall 
just above symphysis to form loose fold between bladder and 
symphysis, then passing to summit of bladder without cover- 
ing its anterior wall, thus forming prevesical space (space of 
Retzius) . 

Describe the endocardium. 

Is continuous with the tunica intima of the vessels at the 
base of the heart, lines both auricles and both ventricles, and 
forms, strengthened by fibrous tissue, the several valves of 
the heart. 

What parts of the brain does the Pons Varolii connect? 

Cerebellum with posterior quadrigeminal bodies (testes), 
one cerebellar hemisphere with the other, parts below (cord 
and medulla) with cerebral hemispheres above. 

Name the ganglia connected with the 5th pair of cranial 
nerves. 

Gasserian, ophthalmic, spheno-palatine (Meckel's), otic, 
submaxillary. 

Give an anatomical description of the bronchial tubes. 

Formed by division of trachea; right and left bronchial 
tubes pass into right and left lungs respectively at root of 
lung, dividing and subdividing, finally becoming bronchioles. 
Each consists of rings or plates of cartilage held together by 
an elastic membrane, and are lined by mucous membrane 
possessing ciliated columnar epithelial cells in larger tubes 
and squamous cells in smallest tubes. 

Name the branches of the subclavian artery. 

Vertebral, internal mammary, thyroid axis (inferior thy- 
roid, transverse cervical, suprascapular) , superior intercostal. 

Describe the inguinal canal. 

Is a flat-sided passage in the lower part of the inguinal 



ANATOMY. 521 

region, extending between internal and external abdominal 
rings; its "floor" is formed by transversalis fascia meeting 
Poupart's ligament; its "roof" by conjoined tendon (internal 
oblique and transversalis muscles) ; anterior wall by skin, 
superficial fascia, aponeurosis of external oblique, internal 
oblique; posterior wall by transversalis fascia, pre-peritoneal 
fat and peritoneum. Is about iy 2 inches long in adult, trans- 
mitting spermatic cord in male and round ligament in female. 

Locate and describe the ileo=caeca! valve. 

Is found at junction of ileum with caecum, formed by 
ileum passing upward and outward to the right to meet large 
bowel obliquely; its orifice is a horizontal slit projecting into 
caecal lumen. 

Describe either the ascending or descending vena cava. 

Ascending vena cava is formed by union of the two common 
iliac veins upon body of fifth lumbar vertebra, passes upward, 
resting on bodies of vertebra to right of aorta, pierces dia- 
phragm at caval opening, and almost immediately enters right 
auricle. Its tributaries are lumbar veins, right spermatic 
vein (or ovarian), renal veins, hepatic veins, phrenic veins. 

Name the bones that form the ankle=joint and give their 
relations. 

Tibia and fibula above, with internal and external malleoli, 
respectively, forming mortise for astragalus, whose trochlear 
surface and sides fill up the space between the two bones of 
the leg. 

What muscles form the quadriceps extensor crureus and 
where is its conjoined tendon inserted? 

Rectus femoris, vastus externus, vastus internus ; crureus; 
tendon is inserted into tubercle of tibia. 

With what bones does the malar articulate? 

Frontal, superior maxilla, temporal, sphenoid. 



522 ANATOMY. 

What arteries supply the bladder in the male, and from 
what are they branches? 

Superior, middle and inferior vesicle, branches of anterior 
trunk of internal iliac. 

In an amputation of the forearm, 3 inches above the 
wrist, what arteries will it be necessary to tie, and of 
what are they branches? 

Radial and ulnar arteries, branches of the brachial ; anterior 
and posterior interosseous arteries, branches of the ulnar. 

Name the ductless glands. 

Spleen, suprarenal bodies, thyroid, thymus. 

Locate the 4th ventricle of the brain. 

Floor is formed by medulla and pons, borders by inferior 
and superior peduncles of cerebellum, with middle peduncles 
at lateral angles; roof is formed by valve of Vieussens, or 
superior medullary velum, above, inferior medullary velum 
and tela choroidea inferior below. 

Locate and briefly describe the gall=bladder. 

Is placed upon under surface of right lobe of liver, in so- 
called fissure for gall-bladder; fundus projects beyond ante- 
rior border of liver. Is a pear-shaped sac covered by perito- 
neum, having a rounded end called the fundus, and a 
constricted posterior extremity known as the neck, which is 
continued into the cystic duct. Its wall is composed of 
fibrous and muscular tissue, and it is lined with mucous 
membrane, which is thrown into cork-screw-like folds at the 
neck and beginning of the cystic duct. 

Describe the oesophagus as to (a) location, (b) dimen= 
sions, (c) arterial supply. 

Is located behind trachea, and in posterior mediastinum, 
extending from lower end of pharynx to cardiac end of stom- 
ach at oesophageal orifice of diaphragm. It is 10 inches long; 
its arterial supply is by branches from the inferior thyroid 



ANATOMY. 523 

(thyroid axis of subclavian), thoracic aorta, gastric (coeliac 
axis), left phrenic. 

Describe the rectum as to structure, length and con= 
tained glands. 

Extends from third piece of sacrum to anus, curved for- 
ward. From third piece of sacrum to tip of coccyx is par- 
tially covered by peritoneum. Its walls consist of peritoneum 
or fibrous tissue externally, within which is muscular coat of 
longitudinal and circular fibres; then comes submucosa sup- 
porting mucous membrane, the latter forming fixed, trans- 
verse folds (plicae recti, or valves of Houston) two or three 
in number, extending transversely around portion of rectum. 
Glands are of mucous variety. 

Name the foramina at the base of the skull, and the 
structures transmitted through each. 

Foramen magnum : Spinal cord, meninges, spinal accessory 
nerves, vertebral arteries. Posterior condyloid (inconstant) : 
Veins. Anterior condyloid (2) : Hypoglossal nerves. Mas- 
toid: Emissary vein. Internal auditory meatus: Auditory 
and facial nerves, auditory artery. Jugular foramen : Lateral 
and inferior petrosal sinuses, glosso-pharyngeal, pneumogas- 
tric and spinal accessory nerves. Hiatus^ Fallopii: Great 
superficial petrosal nerve. Middle lacerated foramen: In- 
ternal carotid artery, sympathetic plexus. Foramen spino- 
sum: Middle meningeal artery. Foramen_pvale : Mandibular 
division of sensory root of fifth cranial nerve and motor root 
of fifth. Foramen_rotundum : Maxillary division of fifth. 
Vidian^ canal : Vidian nerve. Optic foramen: Optic nerve 
and ophthalmic artery. Sphenoidal fissure: Motor oculi, 
trochlear and abducens nerves, ophthalmic division of fifth, 
ophthalmic vein. Olfactory foramina : Olfactory nerves. 

Describe the female urethra as to(a)location,(b)dimen= 
sions, (c) structure. 

Is located anterior to vagina, extending from internal uri- 
nary meatus (neck of bladder) to external urinary meatus 



524 ANATOMY. 

in vestibule, close to anterior margin of vaginal orifice. It 
is iy 2 inches long and quite dilatable. Is lined with mucous 
membrane (squamous epithelium, stratified) which is thrown 
into longitudinal folds, and is surrounded by an areolar coat 
and by muscular layers containing inner longitudinal and 
outer circular fibres, with an abundance of yellow elastic 
tissue and many vessels, especially veins. 

What is contained in the right hypochondriac region? 

Part of right lobe of liver, part of gall-bladder, part of 
ascending colon, hepatic flexure, part of right kidney. 

What muscles form the tendo Achillis, and where is the 
tendon inserted? 

Gastrocnemius and soleus; inserted into posterior part of 
os calcis. 

What forms the internal malleolus of the ank!e=joint? 

The lower end of the tibia. 

Describe the bones of the foot, giving their divisions 
and articulations. 

Tarsus consists of os calcis, astragalus, cuboid, scaphoid, 
cuneiform bones, (internal, middle and external) ; metatarsus 
consists of five bones; phalanges number fourteen. Astra- 
gulus articulates with tibia, fibula, os calcis, scaphoid. Os 
calcis articulates with astragalus, cuboid. Scaphoid articu- 
lates with astragalus and three cuneiform bones. Cuneiform 
bones articulate with scaphoid behind, with each other lat- 
erally, and with first, second, third and fourth metatarsal 
bones in front. Metatarsals articulate with three cuneiform 
and cuboid behind, with each other, and with first phalanges. 
Phalanges articulate with metatarsals and with each other. 

Name the articulations of the occipital bone. 

Atlas, two parietals, two temporals, sphenoid. 

What are the special characteristics of the left ven= 
tricle of the heart? 

It forms the apex of the heart ; its wall is thicker than that 



ANATOMY. 525 

of the right ventricle; its musculi papillares are fewer in 
number and larger; auriculo-ventricular valve (mitral) is 
made up of two segments. 

Describe the auditory apparatus. 

Consists of three divisions, viz., external, middle and in- 
ternal ear. Auricle is attached to temporal bone, is made 
up of elastic cartilage, leads into external auditory meatus, 
at bottom of which is obliquely placed membrana tympani. 
Middle ear is narrow cavity in petrous bone, Eustachian 
tube connecting it with the naso-pharynx ; mastoid antrum 
is in upper posterior part, leading into mastoid cells; it is 
lined with mucous membrane. The internal ear consists of 
osseous labyrinth containing membranous labyrinth, and is 
made up of vestibule, cochlea and three semicircular canals. 
To membranous labyrinth auditory nerve is distributed. 

With what bones does the radius articulate? 

Humerus, ulna, scaphoid and semilunar. 

Name the branches of the abdominal aorta. 

Two phrenics, coeliac axis (brs. gastric, hepatic, splenic), 
superior and inferior mesenteric, suprarenals, renals, lumbar 
arteries (4), spermatic or ovarian, middle sacral and right 
and left common iliacs. 

What are the anterior and posterior boundaries of the 
axilla, and what arteries and nerves pass through it? 

Anterior boundary: Pectoralis major and minor. Poste- 
rior boundary: Subscapulars, teres major and latissimus 
dorsi. Arteries passing through: Axillary and its branches 
(superior thoracic, acromial thoracic, long thoracic, alar tho- 
racic, subscapular, anterior and posterior circumflex). 
Nerves passing through : Brachial plexus, consisting of outer, 
middle and inner cords, with branches as follows: Mus- 
culo- cutaneous, internal and lesser internal cutaneous, cir- 
cumflex, ulnar, musculo-spiral, median. 



526 ANATOMY. 

Give the origin and distribution of the third division 
of the fifth pair of nerves. 

Origin : From Gasserian ganglion at apex of petrous bone, 
passes through foramen ovale with motor root, with which it 
now unites; divided into anterior and posterior divisions, 
anterior being mostly motor to muscles of mastication (tem- 
poral, pterygoids, masseter), posterior division forming infe- 
rior dental, which furnishes mylo-hyoid to muscle of same 
name, branches to teeth, incisor and mental branches; auri- 
culotemporal, sensory to ear and temple; lingual, which re- 
ceives chorda tympani branch of facial and is distributed to 
tongue. 

Bound Scarpa's triangle, and mention the vessels and 
nerve in it. 

Is bounded by Poupart's ligament above, sartorius exter- 
nally, adductor longus internally; vessels are common and 
superficial femoral, profunda femoris arteries; femoral vein; 
nerve is anterior crural. 

Give the location and describe the anatomical struc= 
ture of the kidneys. 

Are placed in loins, resting upon psoas magnus and quad- 
ratus lumborum muscles, upper end of left reaching as high 
as upper border of 11th rib, upper end of right as high as 
lower border of 11th rib. Each is capped by suprarenal body, 
is surrounded by capsule and perirenal connective tisseu con- 
taining fat, is supplied by renal artery, and drained by renal 
vein and lymphatics; nerves from renal plexus of sympa- 
thetic system. The kidney is bean-shaped, notch upon inner 
border is called the hilum, leading into a depression or 
cavity known as the sinus; here the renal duct, or ureter, 
begins and the vessels and nerves enter or leave. The interior 
of the gland consists of a connective tissue parenchyma sup- 
porting vessels and uriniferous tubules, arranged as cortex 
and medulla; the cortex contains the glomeruli (coiled-up 
blood vessel — "little ball of yarn") and some of the tubules; 
the medulla consists of pyramids (Malpighian or medullary) 



ANATOMY. 527 

made up of parallel collecting tubules, which terminate upon 
the apex of the pyramid, pouring urine into the calices of the 
"pelvis of the kidney,'' the upper expanded portion of the 
ureter. The uriniferous tubules begin around a glomerulus 
as a closed extremity (capsule of Bowman), then pass tor- 
tuously through the cortex down into the medulla and back 
again into the cortex (loop of Henle), terminating in one of 
the collecting tubules found in the pyramid of Ferrein, whose 
base is in apposition with the base of a medullary pyramid. 

Describe the mesentery. 

Is a double fold of peritoneum attached to posterior ab- 
dominal wall in an oblique line extending between the left 
side of the body of the second lumbar vertebra to the right 
sacro-iliac joint, a distance of about eight inches. Between 
its two layers are found arteries, veins, lymphatics (lacteals), 
lymphatic nodes (mesenteric "glands"), and more or less 
fat; to its expanded, convoluted edge the small intestine is 
attached, the mesenteric layers surrounding it and constitut- 
ing its serous covering. 

Name the subdivisions of the alimentary canal, and give 
the name and location of the various glands found in the 
small intestine. 

Mouth, pharynx, oesophagus, stomach, duodenum, jejuno- 
ileum; ascending, transverse, descending and sigmoid colon; 
rectum, anus. Glands in small intestine :. Duodenal ("Bru- 
ner's"), in duodenum; intestinal follicles ("crypts of Lie- 
berkuhn"), in whole length of small and large intestine; 
solitary glands, in wall of small intestine, collected into colo- 
nies in ileum, then known as Peyer's patches. 

Give a brief yet comprehensive description of the heart. 

Base corresponds to upper level of third costal cartilage, 
one inch to right of sternal margin and one-half inch to left; 
apex to fifth intercostal space just internal to vertical line 
drawn through left nipple ; base is directed upward and back- 
ward to the right, apex downward, forward and to the left. 



528 ANATOMY. 

Is surrounded by fibro-serous sac called pericardium, consist- 
ing of two layers, fibrous externally, serous internally, the 
latter lining sac (parietal layer) and covering heart (visceral 
layer), it is attached to central tendon of diaphragm. 
Right auricle has openings of superior and inferior venae 
cavae and coronary sinus ; right ventricle receives blood from 
right auricle through right auriculo-ventricular opening 
(tricuspid valve), and expels it through conus arteriosus into 
pulmonary artery, which is guarded by pulmonary semilunar 
valve; right ventricle contains columnae carneae, musculi 
papillares, chordae tendineae attached to tricuspid valve seg- 
ments ; left auricle has four openings for pulmonary veins 
and left auriculo-ventricular opening, guarded by mitral 
valve; left ventricle has columnae carneae, etc., like right, 
its wall is thicker ; it forms apex of heart, and blood leaves it 
by passing into aorta, which is guarded by aortic semilunar 
valve; coronary arteries (2), branches of aorta above semi- 
lunar valve, supply heart muscle. Heart is lined with endo- 
cardium. Pneumogastrics and cardiac plexuses of sympa- 
thetic nervous system supply heart. 

What forms the external malleolus? 

Lower end of fibula. 

Describe one of the vertebrae. 

Consists of centrum, or body, projecting anteriorly, with 
arch behind, made up of two (lateral) pedicles, converging 
laminae to form spinous process, transverse process on each 
side, superior and inferior pair of articular processes, inter- 
vertebral notch on under side of each pedicle. 

Describe the position of the palmar arterial arches. 

Superficial palmar arch is placed upon tendons of flexor 
sublimis digitorum, extending across palm at level of line 
drawn transversely at angle of web between thumb and index 
finger; deep arch lies upon metacarpal bones and interossei 
muscles, one-half inch nearer carpus than superficial arch. 



ANATOMY. 529 

What bloodvessels pass to and from the liver? 

To it, hepatic artery, portal vein; umbilical vein in foetus; 
from it, hepatic veins. 

Describe the pyloric orifice of the stomach. 

Is directed backward and to right, is near neck of gall- 
bladder, consists of special thickening of stomach wall pro- 
duced by circular muscular fibres, which have sphincter-like 
action. 

What tissues of the abdominal wall are divided in the 
operation for appendicitis? 

Skin, superficial fascia, external oblique muscle, internal 
oblique and transversalis muscles, transversalis fascia (pre- 
peritoneal fat) , peritoneum. Or, skin, superficial fascia, linea 
semilunaris, transversalis fascia, peritoneum. 

Give the distribution of the third cranial nerve. 

Motor oculi is distributed to all of ocular muscles except 
external rectus and superior oblique; also sends branch to 
ophthalmic ganglion, finally to be distributed to sphincter 
pupillae of iris and ciliary muscle. 

With what bones does the frontal articulate? 

Both parietal, both malar, both nasal, both lachrymal, both 
maxillae (superior), ethmoid, sphenoid. 

Describe the structure of the prostate gland and give 
its anatomical relations. 

It possesses a capsule of fibrous tissue, enclosing voluntary 
and involuntary muscle and branched tubular glands opening 
into prostatic urethra; base is closely applied to "neck" of 
bladder, circular muscular fibres of which are continued 
around prostatic urethra, which pierces prostate from base 
to apex; behind is rectum; in front is pubo-prostatic plexus 
of veins separating it from symphysis pubis; ejaculatory 
ducts pass through gland between middle and lateral lobes. 

With what bones does the clavicle articulate? 

Sternum, cartilage of first rib, scapula. 
34 



530 ANATOMY. 

Give the external boundary of the popliteal space. 

Lower part of biceps of thigh and its tendon of insertion, 
close to which is external popliteal nerve ; below by outer head 
of gastrocnemius and plantaris. 

Give the origin and distribution of the median nerve. 

Formed by branch from outer and one from inner cord of 
brachial plexus in axillary space, over front of axillary artery, 
is in close relation to brachial artery to bend of elbow, when 
branches are distributed to all superficial muscles in front of 
forearm except flexor carpi ulnaris ; a branch known as ante- 
rior interosseous supplies outer half of flexor profundus, flexor 
longus pollicis and pronator quadratus (deep muscles) ; in 
the palm the median is distributed to integument of flexor 
surface of thumb, index, middle and middle-finger half of 
ring finger and their contiguous sides, and dorsum of distal 
segment of thumb and fingers (2%), motor branches to ab- 
ductor and opponens pollicis, superficial head of flexor brevis 
pollicis and two outer lumbricales. 

Where is the fissure of Sylvius and what artery does it 
contain? 

Begins at anterior perforated space, separates frontal and 
parietal lobes from temporal lobe, passes upward and back- 
ward to terminate in parietal lobe; contains middle cerebral 
artery. 

Name the branches of the brachial artery. 

Superior profunda, nutrient, muscular, inferior profunda, 
anastomotica magna, radial and ulnar (terminals). 

Name the component parts of the spermatic cord. 

Spermatic artery, spermatic veins (pampiniform plexus), 
vas deferens, deferential artery and deferential veins, lym- 
phatics, nerves (spermatic plexus of sympathetic). 

What nerves supply the tongue? 

Hypoglossal, lingual of fifth (including chorda tympani 
branch of facial) , glossopharyngeal. 



ANATOMY. 531 

What forms the internal hamstrings? 

Tendons of semitendinosus. semimembranosus, gracilis. 

Describe the location of the intercostal arteries. 

In the intercostal groove near the lower border and inner 
surface of the rib; anteriorly it occupies the upper part of 
the intercostal space. 

What bone forms the heel and with what does it arti= 
culate? 

Os calcis; with astragalus and cuboid. 

What arteries supply the heart with blood, and where 
do they originate? 

Coronary (2), springing from arch of aorta just above 
sinuses of Valsalva of aortic semilunar valve. 

Name the structures located in the inguinal canal and 
give their anatomical relations. 

Spermatic cord in male, round ligament in female. Are in 
relation with walls of inguinal canal, which are, anterior, 
external oblique aponeurosis entire length, conjoined tendon 
(internal oblique, transversalis) for outer third; posterior, 
transversalis fascia and, at inner end, insertion of conjoined 
tendon; floor is formed by Poupart's ligament and trans- 
versalis fascia ; roof by arched fibres of conjoined tendon. 

Describe the thoracic duct. 

Begins upon body of second lumbar vertebra in dilated 
pouch called receptaculum chyli, passes through aortic open- 
ing in diaphragm, then through posterior mediastinum, and 
at base of neck arches to left, terminating at junction of left 
subclavian and internal jugular veins. It drains the lymph 
from all parts of body except right upper extremity, right 
side of head and neck, right half of thorax (right lung and 
right side of heart) and upper surface of liver. 

Describe the pleura. 

A closed serous sac lining the thoracic wall (parietal layer), 



532 ANATOMY. 

from which it is reflected to the lung, investing it (visceral 
layer) , dipping into the fissures and sending process from 
root of lung to diaphragm (ligamentum latum pulmonis). 

Name the seven openings into the pharynx. 

Two posterior nares, two Eustachian orifices, mouth, larynx, 
oesophagus. 

Locate and describe the spleen. 

Is in the left hypochondriac region, dorsally, to left of 
fundus of stomach and to left of tail of pancreas; is in con- 
tact with under surface of diaphragm, which separates it 
from 8th, 9th, 10th and 11th ribs. It has convex outer sur- 
face, antero-internal and postero-internal surfaces, is entirely 
covered by peritoneum, at hilum splenic artery breaks 
up into branches to enter gland (ductless) and splenic 
vein leaves interior. Anterior border is notched; capsule 
invests it and sends trabecular into interior at hilum, 
dividing it into compartments, or areolae, which contain 
splenic pulp. "Wall of arteriole becomes thickened with lym- 
phoid material, which thickenings are known as Malpighian 
corpuscles. Minute arterioles terminate abruptly in areolae, 
where blood mixes with splenic pulp. Color of spleen is 
purple. 

What bones make up the pelvis? Give the gross 
anatomy of the bony pelvis. 

Two ossa innominata (ilium, ischium, os pubis), sacrum and 
coccyx. Bony pelvis consists of upper expanded portion 
called the false pelvis, and lower slightly cordiform cavity 
known as the true pelvis. The true pelvis has inlet, cavity 
and outlet, conjugate (antero-posterior), transverse and ob- 
lique diameters. 

Mention the muscular and the ligamentous attachments 
of the patella. 

Quadriceps extensor femoris (rectus, vastus internus and 
externus, crureus) ; ligamentum patellae. 



ANATOMY. 533 

Describe the wrist=joint. 

Is formed by radius and triangular cartilage above, sca- 
phoid, semilunar and cuneiform below. (Ulna is separated 
from cuneiform by triangular interarticular cartilage, hence 
is excluded from wrist-joint). Ligaments are atnerior and 
posterior, external' and internal lateral. Movements are 
flexion, extension, abduction, adduction, circumduction. 

What muscles assist in mastication? In deglutition? 

(a) Temporal, internal and external ptygeroids, masseter. 
(b) Mylo-hyoid, digastric, stylo-hyoid (first part of act) ; 
omo-hyoid, sterno-hyoid, sterno-thyroid, thyro-hyoid (second 
part of act) . 

State (a) the nerve supply of the rectum, (b) the blood 
supply of the rectum. 

(a) Sympathetic branches from inferior mesenteric and 
hypogastric; plexuses inferior hemorrhoidal, branch of in- 
ternal pudic. (b) Superior and middle hemorrhoidal arter- 
ies, branches of inferior mesenteric and anterior trunk 
of internal iliac respectively; inferior hemorrhoidal, branch 
of internal pudic. 

Describe the internal jugular vein. 

Is formed just below jugular foramen by lateral and infe- 
rior petrosal sinuses; courses down neck beneath anterior 
border of sterno-cleido-mastoid muscle, in a common sheath 
with the internal carotid (above), common carotid (below), 
and pneumogastric nerve, the latter behind and between, and 
the artery to the inner side of the vein, which partially over- 
laps the artery. Behind sternal end of clavicle it unites with 
subclavian to form innominate vein. 

Give the course and relations of Stenson's duct. 

Is formed in parotid gland, emerges from its anterior bor- 
der, resting upon masseter muscle a finger's breadth below 
zygoma; it4hen perforates buccinator muscle, runs forward 
ajidr^nerces mucous membrane of cheek wall opposite upper 
middle molar tooth. 



534 ANATOMY. 

Describe the Fallopian tubes and give their relations. 

Oviducts are attached to cornua of uterus, extend laterally 
to a point near pelvic brim, here expanding into fimbriated 
extremity; one of the fimbriae is attached to ovary (tubo- 
ovarian ligament). Each tube is lined with mucous mem- 
brane thrown into folds, possessing columnar, ciliated epithe- 
lial outside of which is muscular coat of internal cir- 
cular and external longitudinal fibres, the whole being covered 
by peritoneum of broad ligament. Ovarian and uterine 
arteries anastomose along their lower border; fimbriated ex- 
tremity is in close relation to ovary; outer part of broad 
ligament, extending from tube to pelvic wall, is called infun- 
dibulo-pelvic ligament, and contains ovarian artery and veins. 

Describe the dura mater. Mention the processes and 
sinuses of the dura mater. 

,Forms the lining or endosteum of cranial cavity, and 
extends through foramen magnum into neural canal as ex- 
ternal layer of theca of cord; is tough and fibrous, forms 
projections or shelves in cranial cavity for support of 
encephalon. These are falx cerebri, falx cerebelli, tentorium 
cerebelli. Dura consists of two layers, endosteal and menin- 
geal, which separate at certain places to permit the entrance 
of the tunica intima of a vein, thus forming venous sinuses 
of cranium. These are superior and inferior longitudinal, 
straight, two lateral, occipital, two superior and inferior 
petrosal, transverse, circular, and two cavernous. 

Give the macroscopic and the microscopic appearance of 
(a) kidney tissue, (b) lung tissue, (c) nerve fiber. 

(a) Kidney tissue is moderately firm, somewhat granular, 
reddish-brown in color. Microscopically it presents glomer- 
uli, uriniferous tubules, blood vessels and interstitial con- 
nective tissue, (b) Lung tissue is of a mottled pink color, 
soft and porous. Under the microscope it shows bronchioles 
(fibrous wall of elastic tissue lined with mucous membrane) 
and alveoli, dilatations lined with mucous membrane of squa- 
mous epithelial cells, outside of which are seen capillary blood 






ANATOMY. 535 

vessels, (c) Nerve fibre is cord-like, soft and white. Histo- 
logically it consists of axis cylinder surrounded by white 
substance of Schwann (medullary substance) (absent in non- 
medullated nerves) and encased in the neurilemma. Inter- 
ruptions in the medullary substance occur (nodes of Ranvier). 

What anatomic parts are normally found in the left 
hypochondriac region? 

Fundus of stomach, spleen and tail of pancreas, splenic 
flexure of colon, part of left kidney. 

Give in language or by drawing, the normal curvatures 
of the spinal column, and describe a typical cervical 
vertebra. 

Curves are cervical, thoracic, lumbar, sacro-coccygeal ; 
convexity is forward in cervical, backward in thoracic, 
forward in lumbar, backward in sacro-coccygeal. The line 
of gravity of the trunk passes through the chords of 
these curves. A typical cervical vertebra consists of a small 
body, diverging pedicles, a bifid spinous process, bifid trans- 
verse processes grooved on upper border, with a costo-trans- 
verse foramen for vertebral artery at base of transverse pro- 
cess ; neural foramen is relatively large. 

Name the bones and ligaments of the ankle=joint. 

Tibia, fibula, astragalus; anterior and posterior, internal 
(deltoid) and external lateral. 

Name the principal muscles that keep the body erect 
on the thigh and give the origin and insertion of any one 
of them. 

Gluteus maximus, gluteus medius, gluteus minimus ham- 
strings; gluteus maximus takes its origin from outer surface 
of ilium between posterior part of crest and superior gluteal 
line, from vertebral aponeurosis, two last pieces of sacrum, 
posterior surface of great sacro-sciatic ligament, and is in- 
serted into gluteal ridge of femur and ilio-tibial band of 
fascia lata. 



536 ANATOMY. 

Give the origin, distribution and branches of the middle 
meningeal artery. 

Is branch of internal maxillary, passes through foramen 
spinosum of sphenoid, traverses wall of middle cranial fossa, 
dividing into anterior and posterior branches (meningeal) 
supplying dura and bony wall of cranium. 

Where does the glossopharyngeal nerve rise and what 
structures are supplied by this nerve and its branches? 

Arises from groove between olivary and restiform bodies, 
passes out of cranial cavity through jugular foramen, divides 
into lingual and pharyngeal branches, supplying mucous 
membrane of posterior part of tongue ( circum vallate papillae) 
and mucous membrane of pharynx. A branch (Jacobson's) 
is distributed to tympanum. 

Describe the pharynx. 

Belongs to both respiratory and alimentary tracts, is lined 
with mucous membrane possessing ciliated columnar cells 
above, and squamous, stratified cells below level of soft palate ; 
pharyngeal aponeurosis is between mucous membrane and 
constrictor muscles; constrictor muscles are three in number, 
superior, middle, inferior. Pharynx is flattened antero-pos- 
teriorly, is widest opposite greater cornua of hyoid bone, and 
communicates with posterior nares, with middle ears by 
Eustachian tubes, with mouth, larynx and oesophagus. The 
pharyngeal tonsil is located upon upper posterior wall, and 
consists of a special collection of adenoid tissue, which is 
found more or less freely distributed throughout naso- 
pharynx. 

Name the regions of the abdomen. 

Draw transverse line through anterior superior iliac spines ; 
also through costal cartilages of 10th ribs; intersect with 
vertical lines through center of Poupart's ligament. Nine 
regions thus formed are, from above downward, right and 
left hypochondriac, epigastric, right and left lumbar, umbil- 
ical, right and left inguinal, hypogastric. 



ANATOMY. 537 

Locate and describe the caecum. 

First part of large intestine, found below ileo-caecal junc- 
tion in right iliac fossa ; is entirely surrounded by peritoneum, 
possesses sacculations, that upon right side usually larger, 
thus throwing original (foetal) apex to left, at which point 
appendix vermiformis is attached. Longitudinal muscular 
bands well denned. 

Describe the eyeball and give its parts. 

Is spherical in shape, embedded in orbital fat, has ocular 
muscles attached to it, is perforated by optic nerve and ciliary 
arteries and veins, posterior five-sixths opaque, anterior one- 
sixth transparent. Its walls are made up of sclerotic ana 
cornea, uveal tract (choroid) and retina, enclosing crystalline 
lens and vitreous body. Behind cornea is anterior chamber 
containing aqueous humor ; in front of crystalline lens is iris. 

Give the names of five muscles of the male perineum. 

Ischio-cavernosus, compressor urethral, bulbo-cavernosus, 
transversus perinei, sphincter ani externus. 

Name five muscles of the back of the leg. 

Gastrocnemius, plantaris, soleus, tibialis posticus, flexor 
longus digitorum. 

Name the principal divisions and subdivisions of the 
internal carotid artery. 

It divides, after passing through cavernous sinus, into ante- 
rior and middle cerebral arteries; its subdivisions are oph- 
thalmic and posterior communicating. 

How is the eye supplied with blood? 

By the ophthalmic artery, forming ciliary branches • and 
arteria centralis retinae. 

What is the circle of Willis? 

An arterial anastomosis at base of brain, formed by internal 
carotid arteries as follows: Each internal carotid sends for- 
ward the anterior cerebral, which is connected with the oppo- 



538 ANATOMY. 

site anterior cerebral by the anterior communicating; it 
furthermore sends backward the posterior communicating 
which meets the posterior cerebral, which is a branch of the 
basilar. 

Name and bound the ventricles of the brain. 

The lateral ventricles (first and second) are bounded above 
by corpus callosum; below by intraventricular portion of 
corpus striatum, taenia semicircularis, choroid plexus, optic 
thalamus, posterior pillar of fornix, corpus fimbriatum; in- 
ternally by septum lucidum. Third is bounded above by 
velum interpositum ; below by gray matter at base of brain, 
i. e., lamina cinerea, tuber cinereum, corpora albicantia, pos- 
terior perforated space and tegmenta of crura cerebri; later- 
ally by optic thalami; anteriorly by lamina cinerea and 
anterior pillars of fornix; posteriorly by posterior commis- 
sure and pineal gland (epiphysis cerebri). Fourth ventricle 
is bounded above by valve of Vieussens (superior medullary 
velum) , in the middle by epithelial lining and pia ; j3elow 
by inferior medullary velum; floor is formed above by pons, 
below by medulla; sides are formed by superior, middle and 
inferior cerebellar peduncles. 

Describe the sympathetic nerve, naming and locating the 
principal ganglia. 

Consists of a double chain of ganglia extending along 
either side of vertebral column anteriorly, connected by 
branches with each other and with spinal nerves (rami com- 
municantes), furnishing branches to blood vessels (vaso- 
motor nerves) and forming plexuses — three prevertebral 
plexuses and numerous secondary plexuses around arteries. 
Principal ganglia are ophthalmic, in back part of orbit , 
spheno-palatine, in spheno-maxillary fossa; submaxillary, 
upon submaxillary gland; semilunar, upon aorta around 
coeliac axis. 

Give the origin, insertion and action of any one of the 



ANATOMY. 539 

following muscles: occipito=frontaIis, deltoid, gastrocne= 
mius. 

Deltoid arises from outer third anterior border of clavicle, 
outer margin of acromion, lower border of spine of scapula, 
entire length, and is inserted into deltoid impression upon 
outer surface of middle of shaft of humerus. Action, to 
abduct arm to horizontal position. Nerve, circumflex. 

What arteries unite to form the basilar artery? 

The two vertebrals. 
Describe the tongue. 

Consists of intrinsic and extrinsic muscles. Intrinsic are 
different divisions of lingualis (superior, inferior, transverse 
and vertical) ; extrinsic are geniohyoglossus, hyoglossus, 
styloglossus, palatoglossus. Tongue is supported by hyoid 
bone, is covered by mucous membrane thickly set with papillae, 
viz., circumvallate at base, fungiform and filiform upon dor- 
sum and margin. Nerves: motor,hypoglossal ; sensory and 
gustatory, glossopharyngeal, lingual, chorda tympani. 

Describe the pia mater. 

Innermost of three meninges, is closely applied to central 
nervous system, supporting blood vessels, dipping down into 
sulci and passing into general ventricular cavity of ence- 
phalon to develop choroid plexuses — vascular fringes found 
in lateral, third and fourth ventricles. 

Describe the bones of the hand with their divisions and 
articulations. 

Carpus, metacarpus, phalanges. Eight carpal bones: sca- 
phoid, semilunar, cuneiform, pisiform, trapezium, trapezoid, 
os magnum, unciform. Five metacarpal bones; fourteen 
phalanges. Carpal articulate with each other and with bases 
of metacarpals; scaphoid and semilunar articulate with ra- 
dius; cuneiform with triangular interarticul ar cartilage be- 
tween it and ulna; metacarpals articulate with each other at 
their bases and with first phalanges at their heads ; phalanges 
articulate with each other and with metacarpals. 



540 ANATOMY. 

Describe the hip=joint. 

Enarthrodial, or ball-and-socket joint, formed by acetab- 
ulum and head of femur, surrounded by capsule, most im- 
portant and strongest part of which is found upon the anterior 
aspect of the joint, extending between anterior inferior spine 
of ilium and anterior intertrochanteric line (spiral line of 
femur), and is known as the "Y" ligament (ilio-femoral). 
This ligament prevents hyperextension of thigh upon pelvis, 
or falling backward of trunk. Capsule is attached to innomin- 
ate bone around margin of acetabulum and to neck of femur ; 
ligamentum teres is attached to head of femur and to bottom 
of acetabulum. Movements permitted: flexion, extension, 
abduction, adduction, rotation and circumduction. 

Name five muscles of the shoulder and arm. Give the 
origin, insertion and action of any one of the five. 

Deltoid, coraco-brachialis, biceps, triceps, teres major. 
Biceps takes origin by two heads, one from coracoid process 
of scapula, the other from upper margin of glenoid fossa, this 
tendon passing through shoulder- joint to reach bicipital 
groove ; insertion is into deep fascia of forearm by semilunar 
(bicipital) fascia, and into bicipital tuberosity of radius; 
action is to flex forearm upon arm, and to supinate hand. 

Give the origin, course and branches of any one of the 
following arteries: brachial, temporal, left common carotid. 

Left common carotid arises from arch of aorta, courses 
upward and outward in line drawn from sterno-clavicular 
joint to mastoid, dividing at level of upper border of thyroid 
cartilage into its only branches, external and internal carotids. 

Describe the hemispheres and lobes of the brain. 

The cerebral hemispheres are ovoid, convex upon superior 
and lateral surfaces, partially separated from each other by 
longitudinal fissure, but connected by corpus callosum. 
Frontal lobe occupies anterior fossa of cranial cavity, sepa- 
rated from parietal lobe by fissure of Rolando, and from 
anterior part of temporal lobe by Sylvian fissure; parietal 



ANATOMY. 541 

lobe is bounded by fissure of Rolando anteriorly, parieto- 
occipital fissure posteriorly, Sylvian fissure inferiorly, great 
longitudinal fissure superiorly ; occipital lobe is found behind 
parietooccipital fissure ; temporal lobe is below fissure Sylvius, 
and rests in middle cranial fossa. 

Where in the topography of the abdomen is the sigmoid 
flexure located? The appendix vermiformis? 

(a) In left inguinal and hypogastric regions, (b) In right 
inguinal region. 

Give the surgical anatomy of femoral hernia. 

Neck of sac is at femoral, or crural, ring formed by Gim- 
bernat's ligament on inner side, femoral vein on outer, Pou- 
part's ligament in front, and horizontal ramus of pubic bone 
behind; is closed by septum crurale; crural canal is narrow 
interval between femoral vein and femoral sheath on inner 
side of vein, and extends from crural ring above to upper 
margin of saphenous opening below. Saphenous opening is 
closed by cribriform fascia. 

Describe the oesophagus. 

Extends from lower margin of cricoid cartilage to stomach, 
is ten inches long, situated behind trachea in neck and in 
posterior mediastinum in thorax; curves forward to oesopha- 
geal opening in diaphragm, through which it passes, accom- 
panied by pneumogastric nerves; wall consists of external 
longitudinal and internal circular muscle fibres, a submucosa 
and a mucous membrane, which is thrown into longitudinal 
folds, and is made up of stratified epithelial cells. 

What is connective tissue? Where in the body is con= 
nective tissue found? 

Connective, or areolar, tissue consists of branched cells, or 
connective tissue corpuscles, the fibres of which interlace and 
form spaces or areola?. It is freely distributed throughout 
the body, forms sheaths of muscles, blood vessels, nerves, etc., 
binds parts together and forms a generally -evenly spread-out 
layer beneath the skin, the superficial fascia. 



542 ANATOMY. 

Into what and how far from the pyloric orifice of the 
stomach does the ductus communis choledochus normally 
open? 

Into the duodenum upon its concave side (descending por- 
tion) three or four inches below the pyloric orifice. 

Give the course, relations and structure of the ureter. 

Begins in the upper expanded portion, the " pelvis of the 
kidney," passes downward behind the peritoneum upon the 
psoas magnus muscle, over the brim of the pelvis into pelvic 
cavity, forward to base of bladder, between rectum and blad- 
der in male, % inch from cervix in female, then between 
vagina and bladder, terminating at posterior angle of trigone. 
It consists of three coats, fibrous, muscular and mucous. 

What constitutes the brachial plexus? 

The 5th, 6th, 7th and 8th cervical nerves and 1st thoracic 
nerve. 

Mention the ligaments, fissures and lobes of the liver. 

Ligaments are five in number, falciform (suspensory), 
round, coronary, right and left lateral; fissures are five in 
number, fissure for round ligament (obliterated umbilical 
vein), for gall-bladder, for ductus venosus, for inferior cava, 
and transverse fissure; lobes are five in number, right, left, 
quadrate, Spigelian, caudate. 

Mention the abdominal muscles. Describe any one of 
these muscles. 

External and internal oblique, transversalis, recti, pyra- 
midales. (Quadratus lumborum, psoas magnus and parvus, 
and iliacus might be included) . Internal oblique takes origin 
from outer half of Poupart's ligament, from anterior two- 
thirds of middle lip of iliac crest, from lumbar aponeurosis, 
from last three ribs; is inserted into linea alba and inner 
extremity of ilio-pectineal line behind Gimbernat's ligament. 
Its aponeurosis divides to form sheath of rectus for its upper 
three-fourths, passing in front of rectus for its lower fourth. 
The line of this division of internal oblique is called linea 



ANATOMY. 543 

semilunaris ; internal oblique unites with transversalis to form 
conjoined tendon. Action is to flex thorax upon pelvis, or 
vice versa, to rotate trunk toward same side, and to compress 
abdominal viscera. 

Locate the principal groups of lymphatic glands. 

Inguinal (superior and inferior), axillary and cervical 
(superficial and deep). 

Give the anatomy of the true vocal cords. 

Are two in number, formed by crico-thyroid membrane, 
attached to retiring angle of thyroid cartilage anteriorly and 
to vocal process of arytenoid cartilage posteriorly; have 
thyro-arytenoid muscle along their outer side. They are 
covered by mucous membrane, which is closely attached and 
thin, and consisting of stratified, squamous epithelial cells. 

Give the point of opening of the parotid duct, of the 
submaxillary duct and of the sublingual duct. 

Parotid duct, in cheek wall opposite middle upper molar 
tooth; of submaxillary duct, in fraenum linguae; sublingual 
duct, close to froenum linguae. 

Describe the ischiorectal fossae and their contents. 

Are located between the lower part of the rectum and the 
ischial tuberosities; are triangular in shape, bounded inter- 
nally by sphincter ani, levator ani and coccygeus muscles; 
externally by tuberosity of ischium; are filled with adipose 
tissue; in outer wall is internal pudic artery; crossing the 
space are inferior hemorrhoidal vessels and nerves. 

Give the origin, insertion and action of any one of the 
following muscles: digastric, sacrolumbalis, rectus ab= 
dominis. 

Rectus abdominis takes its origin- from body of pubic bone 
and from anterior ligaments of pubic symphysis of opposite 
side, is inserted into costal cartilages of 5th, 6th and 7th ribs ; 
contains three transverse lines (lineae transversa?), which 
extend in zigzag style across the muscle in its upper part; 



544 ANATOMY. 

action is to flex thorax upon pelvis, or vice versa, and to 
compress abdominal viscera. 

Give four principal points of distribution of the pneu= 
mogastric or par vagum nerve. 

Pharynx (motor), larynx (motor and sensory), heart 
(superficial and deep cardiac plexuses), stomach (uniting 
with sympathetic system). 

What is contained in the middle mediastinum? 

Heart and pericardium, ascending aorta, lower part of 
superior cava, vena azygos major, both bronchi, pulmonary 
artery and veins, phrenic nerves. 

What anatomical parts are involved in the descent of 
the testes? 

Gubernaculum testes, visceral and parietal layers of peri- 
toneum, transversalis fascia, inguinal canal and rings, internal 
oblique muscle (cremaster muscle and cremasteric fascia), 
intercolumnar fascia. 

Describe the bones forming the ossa innominata. 

Ilium has curved crest extending from anterior superior to 
posterior spine; internally is iliac fossa (false pelvis, limited 
below by ilio-pectineal line) ; externally are superior, middle 
and inferior gluteal lines ; greater sciatic notch is behind, 
partly formed by ischium; anterior inferior spine for rectus 
femoris and ilio-femoral (Y) ligament is below anterior supe- 
rior spine; ilium forms part of true pelvis and two-fifths of 
acetabulum; fuses with os pubis and ischium at 18th to 20th 
year ; articulates with sacrum by auricular surface. 

Ischium has a body above, with spine of ischium projecting 
backward and inward, and separating greater from lesser 
sciatic notches ; lesser sciatic notch is on ischium below spine ; 
tuberosity of ischium is lowest part, from which ramus as- 
cends toward pubic bone and partially bounds obturator 
foramen; ischium forms two-fifths of acetabulum and part 
of true pelvis. 

Os pubis has body (articulates with opposite bone, forming 



ANATOMY. 545 

symphysis pubis) ; horizontal and descending ramus, bound- 
ing obturator foramen; pubic spine for Poupart's ligament; 
ilio-pectineal line extending from body along horizontal 
ramus; on under surface of latter is groove for obturator 
vessels and nerve. 

Describe the sternum, its articulations and the important 
muscles attached to it. 

Consists of manubrium, gladiolus and ensiform appendix; 
suprasternal notch is above, between clavicles; notches are 
found along lateral borders for articulation of first seven 
pairs of ribs (costal cartilages), and at upper outer angles 
of manubrium for clavicles; transverse ridge (subcutaneous 
landmark) exists at line of junction of manubrium and gladi- 
olus, marking level of third rib; ensiform varies in size and 
shape. Important muscles attached are sterno-cleido-mastoid 
and pectoralis major; rectus abdominis and diaphragm are 
attached to ensiform. 

What portion of the bladder is uncovered by peri- 
toneum? 

The anterior wall, which is separated from symphysis pubis 
by prevesical space (cavum Retzii). 

Describe the spinal cord. 

Is contained in neural canal, and extends from lower mar- 
gin of foramen magnum to body of second lumbar vertebra; 
constitutes 2 per cent, of cerebro-spinal axis; is surrounded 
by dura, arachnoid and pia; has two enlargements, cervical 
and lumbar, which mark points of origin of large nerve trunks 
for upper and lower extremities respectively (brachial and 
sacral plexuses) ; white nerve matter surrounds gray, which 
is arranged like two inverted commas (or capital "H"), 
connected by transverse band (gray commissure) ; anterior 
horn of gray matter contains large multipolar cells continuous 
with motor nerves, which appear upon surface of cord at 
antero-lateral aspect; posterior gray horn is continuous with 
35 



546 ANATOMY. 

sensory nerves, which appear upon postero-lateral aspect of 
cord. 

Describe the hyoid bone. 

Is U-shaped, placed, with convexity forward, above thyroid 
cartilage ; consists of centrally located body, two greater cor- 
nua directed backward and two lesser cornua projecting up- 
ward at point of junction of body and greater cornua. Hyoid 
bone serves for attachment of thyro-hyoid membrane and 
ligament and stylo-hyoid ligament; of sterno-hyoid, thyro- 
hyoid, omo-hyoid, genio-hyoid, genio-hyoglossus, hyo-glossus, 
mylo-hyoid, stylo-hyoid and digastric muscles. 

Name the articulations of the superior maxillary bone. 

Frontal, lachrymal, nasal, malar, palate, ethmoid, inferior 
turbinal, vomer and opposite maxilla. 

Name three abdominal muscles and give the origin, in= 
sertion and action of one of them. 

External oblique, rectus abdominis, psoas magnus. 

External oblique. Origin is from outer surface of lower 
eight ribs, anterior half of outer lip of iliac crest; inserted 
into entire length of linea alba, crest, spine and ilio-pectineal 
line of pubic bone, and fascia lata. Junction of its aponeu- 
rosis with fascia lata forms Poupart's ligament, which extends 
from anterior superior iliac spine to pubic spine. Just above 
and to outer side of pubic spine the aponeurosis of external 
oblique forms external abdominal ring; aponeurosis of inser- 
tion is reflected outward from pubic spine along ilio-pectineal 
line, forming Gimbernat's ligament. Action of external 
oblique, to help flex thorax upon pelvis and vice versa; to help 
rotate pelvis toward same side; to compress and help expel 
contents of abdominal viscera. 

Give the origin and distribution of the olfactory nerve. 

Olfactory tract appears upon surface of cerebrum at ante- 
rior perforated space, extends forward, terminating in olfac- 
tory bulb, which rests upon cribriform plate of ethmoid ; from 
under surface of bulb 20 to 30 nerves descend, enter superior 



ANATOMY. 547 

nasal meatus, grooving perpendicular plate and superior and 
middle turbinal processes of ethmoid, and are distributed to 
nasal mucous membrane covering these parts. 

Describe the mammary glands. 

Two hemispherical, lobulated glands placed upon anterior 
thoracic wall over pectoralis major muscle, covering a space 
from the second to the sixth rib, and from margin of sternum 
to anterior margin of axilla. Nipple, sensitive and pigmented, 
projects from center, and contains orifices of lactiferous ducts ; 
areola, also pigmented, surrounds nipple; gland substance is 
arranged in lobules (10 to 20), each of which is a compound, 
racemose gland, and all are surrounded and supported by- 
fibrous tissue forming a capsule. 

Describe each of the tunics of the eye and the differ= 
ent parts of each. 

Sclerotic is outermost, consisting of bundles of fibrous 
tissue closely interlaced, is perforated to nasal side of pos- 
terior pole by optic nerve, and is continuous with cornea 
anteriorly. Six ocular muscles are inserted into it. Cornea 
is transparent, consists of bundles of fibrous tissue enclosing 
corneal spaces, in which are lodged corneal corpuscles; is 
covered by conjunctival epithelium and lined by Descemet's 
membrane; is richly supplied by sensory nerve fibres, but is 
non-vascular. Uveal tract consists of choroid, ciliary body 
and iris, is vascular and pigmented ; choroid is perforated by 
optic nerve behind; ciliary body is made up of ciliary pro- 
cesses and ciliary muscle; iris is placed in front of lens in 
anterior chamber, and is perforated at its center (pupil). 
Retina is innermost tunic, made up of nerve cells and fibres, 
representing an expansion of the optic nerve; macula lutea 
is point of most acute vision, and is located to temporal side 
of optic disk, or point of entrance of optic nerve; retina is 
supplied by arteria centralis retinae, branch of ophthalmic 
artery, and drained by central vein of retina into ophthalmic 
vein. 



548 ANATOMY. 

What are the vesiculae seminales? 

Two dilated pouches placed between bladder and rectum, 
uniting with vasa deferentia to form ejaculatory ducts. 

Give the course of the posterior tibial artery. 

Extends from lower border of popliteus muscle down leg 
between superficial and deep layers of muscles to inner side 
of ankle, where it divides into internal and external plantar 
branches. 

Which of the cranial nerves has the widest distribution? 

Pneumogastric (10th). 

Describe the origin and distribution of the ninth pair of 
cranial nerves. 

Ninth, or glossopharyngeal, nerve has superficial origin 
from groove between olivary and restif orm bodies of medulla ; 
is distributed to pharynx (sensory) and to posterior third 
of tongue, especially to circumvallate papillae. 

In an amputation of the leg five inches below the knee 
what arteries will it be necessary to tie and of what are 
they branches? 

Anterior tibial, branch of popliteal ; posterior tibial, branch 
of popliteal; peroneal, branch of posterior tibial. 

Give the distribution of the radial nerve below the 
wrist. 

To radial half of dorsum of hand, and dorsum of thumb, 
index, middle and middle-finger half of ring finger, except 
distal segments of digits, which are supplied by median nerve. 

What is the linea alba and how is it formed? 

Is the line of fusion of aponeuroses of external and in- 
ternal oblique and transversales muscles, extending from en- 
siform above to symphysis below; just below its center is 
umbilicus. 

Describe the sphincter ani. 

Are two in number, internal, or involuntary, and external, 



ANATOMY. 549 

or voluntary. Internal is formed by circular fibers of rectal 
wall; external is attached to tip of coccyx, surrounds anal 
opening, and is inserted into median line of perineum. 

Describe the periosteum. 

Is closely adherent to outer surface of bone and consists 
of two layers, an outer, fibrous layer, and an inner, vascular 
layer. In young and growing bones the inner is called the 
osteogenetic layer. Nerves and lymphatics are also present 
in periosteum. 

Give the origin, insertion and action of any one of the 
following muscles: tibialis anticus, pronator radii teres, 
gracilis. 

Tibialis anticus arises from upper % of outer surface of 
shaft and under surface of outer tuberosity of tibia, from 
interosseous membrane; is inserted into internal cuneiform 
and first metatarsal bones; action, to flex and invert foot; 
to strengthen and help maintain anteroposterior arch of foot. 

Give a general description of the cerebral veins. 

Remarkable for thinness of their walls due to lack of muscu- 
lar tissue ; they have no valves ; superficial cerebral' veins are 
lodged in sulci between convolutions, receive blood from sub- 
stance of brain and terminate in the sinuses, opening into 
them in the opposite direction to which blood is flowing ; deep 
cerebral veins drain the ventricles into straight sinus; at 
base basilar vein drains interpeduncular space and basal 
ganglia. 

Relate the differences between a virgin uterus and the 
uterus of a multipara. 

Uterus of multipara is larger (especially body), arbor vitaB 
uterinas of cervix is more or less effaced, external os is 
irregular, or perhaps stellate, instead of being a smoothly 
outlined, transversely directed slit. 

Describe a hair follicle in its relations to the skin. 

A hair follicle is an involution of epidermis, forming a 



550 ANATOMY. 

funnel-shaped depression sometimes extending into subcu- 
taneous cellular tissue; is usually placed obliquely and be- 
comes enlarged at bottom to accommodate hair bulb, part of 
which is vascular papilla derived from dermal lining of 
follicle; opening into follicle are ducts of one or more se- 
baceous glands. 

What are the Wormian bones? 

Bones developed from separate centers of ossification to 
fill in gaps between certain of the cranial bones; they are 
found most frequently in lambdoid suture, occasionally oc- 
cupying position of fontanelles, especially posterior. 

Name the humors of the eyeball. 

Aqueous humor, contained in anterior chamber, consists of 
98.6% water, and small quantities of extractives and pro- 
teids ; vitreous humor, occupying the large posterior chamber, 
has about the same composition as aqueous humor. 

State the origin of the sensory division of the fifth pair 
of cranial nerves. 

Superficial origin is from under surface of pons, close to 
anterior border. 

What is the function of the third cranial nerve? 

To supply with motor influence all ocular muscles except 
superior oblique and external rectus, and to furnish motor 
root to ophthalmic ganglion. 

Describe the ramus of the jaw. Mention the muscles 
and ligaments attached to the ramus of the jaw. 

Ramus extends upward and slightly backward, forming 
angle of jaw by its junction with the body; is surmounted 
by coronoid process anteriorly and condyle posteriorly, be- 
tween which is sigmoid notch ; upon inner surface is inferior 
dental foramen. 

Muscles and ligaments attached are : temporal, external and 
internal pterygoids, masseter; capsular and internal lateral 



ANATOMY. 551 

ligament of temporo-mandibular articulation, stylo-mandibu- 
lar ligament. 

Describe the arytenoid cartilages. 

Are pyramidal in shape, rest upon upper, posterior part of 
cricoid cartilage by their bases, have true vocal cord (thyro- 
aretynoid ligaments) attached to vocal process anteriorly; 
lateral crico-arytenoid, posterior crico-arytenoid, arytenoid 
and thyro-arytenoid muscles are also attached. The arytenoid 
cartilages are covered with mucous membrane and between 
them is the interarytenoid space. 

Give the course and relations of the external jugular 
vein. 

Is formed near angle of jaw by union of temporo-maxillary 
and posterior auricular veins, runs downward and outward 
upon sternomastoid muscle and under platysma myoides, to 
empty into subclavian vein at middle of clavicle. 

Mention the branches of the internal iliac artery. 

Anterior trunk: superior, middle and inferior vesical, ob- 
turator, middle hemorrhoidal, uterine, vaginal, internal pudic 
and sciatic. From posterior trunk: ilio-lumbar, gluteal, 
lateral sacral. 

Give the course of the female ureters. 

Eest upon psoas magnus muscles, pass over brim of pelvis 
into cavity of same to base of broad ligaments, then 
y 2 inch from cervix uteri, laterally, obliquely forward and 
inward in anterior vaginal wall to base of bladder. 

What nerves form the pharyngeal plexus? 

Glossopharyngeal, pneumogastric and cervical sympathetic. 
What structures are severed in tracheotomy? 

Skin, superficial and deep cervical fascia and trachea ; per- 
haps anterior jugular vein, or branches, and thyroid isthmus. 

Describe the phrenic nerve. 

Is formed by the fourth cervical nerve, chiefly, passes down- 



552 ANATOMY. 

ward upon anterior surface of scalenus anticus muscle, enters 
superior, then middle, mediastinum and perforates diaphragm 
to supply its under surface. 

Describe the ulnar artery as to (a) origin, (b) course, 
(c) distribution. 

(a) Is one of terminal branches of brachial; (b) is beneath 
superficial flexors of forearm, passes obliquely to ulnar border, 
having ulnar nerve to ulnar side of it for lower % of its 
extent, then curves across palm near lower border of anterior 
annular ligament (superficial palmar arch), first sending 
communicating branch to deep arch, (c) Is distributed to 
structures around internal aspect of elbow, to ulnar side of 
forearm, to interosseous membrane, anteriorly and posteriorly, 
and adjacent muscles, and to palm and flexor surface of 
fingers. 

How are the saphenous veins formed? Where do the 
saphenous veins empty? 

Internal saphenous is formed upon dorsal surface of foot 
and inner border ; external saphenous is formed upon dorsum 
and outer border of foot. Internal saphenous vein empties 
into femoral at saphenous opening in fascia lata; external 
saphenous terminates in popliteal vein. 

Give the situation of the lymphatic glands of the thorax. 

Intercostal spaces posteriorly, anterior and posterior medi- 
astina, around bronchial tubes. 

Give the boundaries and mention the contents of the 
posterior mediastinum. 

Is bounded in front by pericardium and roots of lungs, 
behind by vertebral column and on either side by pleura. It 
contains descending thoracic aorta, greater and lesser azygos 
veins, pneumogastric and splanchnic nerves, oespohagus, thor- 
acic duct and lymphatic glands. 

Describe the interna! abdominal ring. 

Is oval in shape, long axis directed vertically, located in 



ANATOMY. 553 

transversalis fascia % inch above Poupart's ligament and 
midway between anterior superior iliac and pubic spines. 
Structures of spermatic cord pass through it in male, round 
ligament in female. Infundibuliform fascia is attached to 
its margin ; deep epigastric artery courses along inner margin. 

Give a method by which the fissures of Sylvius and 
Rolando may be approximately mapped out on the surface 
of the skull. 

Fissure of Sylvius : Draw a line from a point one inch and 
a quarter horizontally behind external angular process of 
frontal bone to a point % of an inch below parietal eminence. 
Fissure of Rolando: From a point % inch behind mid-point 
of line between glabella and external occipital protuberance, 
draw a line for 3% inches over side of head at angle of 67° 
with median line. 

Locate and describe Peyer's glands. 

Are located in wall of ilium, more numerous at lower 
part; are more or less oval bodies collected together; con- 
sist of adenoid (lymphoid) tissue. 

Describe the tonsils and name some of the arteries 
which supply them with blood. 

Are placed between anterior and posterior palatine arches, 
in tonsillar recess, close to base of tongue, vary greatly in 
size and shape, surface is irregular and marked by numerous 
depressions leading into crypts in substance of tonsil, and are 
surrounded by closed follicles of lymphoid tissue. Arteries: 
dorsalis linguae, ascending palatine and tonsillar of facial, 
descending palatine of internal maxillary, ascending pharyn- 
geal. 

Describe the male urethra and state its divisions. 

Divided into prostatic, membranous and spongy portions; 
prostatic passes through prostate gland, has veru montanum 
and orifices of ejaculatory ducts in its floor, upon either 
side of which are prostatic sinuses with orifices of prostatic 



554 ANATOMY. 

glands; membranous portion is shortest of the three, is con- 
tained between the two layers of triangular ligament, and 
surrounded by compressor urethral muscle ; spongy portion is 
contained in corpus spongiosum, terminates at meatus urin- 
arius externus (least dilatable part of urethra) and has 
several depressions in mucous membrane of roof, largest 
of which, just behind fossa navicularis which is close to 
meatus, is named lacuna magna. 

What is the origin and course of the pulmonary artery? 

Origin is from right ventricle; course is upward and 
slightly to left to under surface of transverse portion of 
aortic arch, where it divides into right and left pulmonary 
arteries for right and left lungs respectively. 

Give the names of the princopal muscles of the back. 

Trapezius, latissimus dorsi, rhomboideus major and minor,, 
erector spinae. 

Give the names of the principal muscles of the back, 
i and nerve, Scarpa's space. 

Femoral vein, femoral artery, anterior crural nerve. 
Locate and describe the rectum. 

Extends from third piece of sacrum to anus, with forward 
curve, is covered by peritoneum in front and on the sides 
only; longitudinal and circular muscular fibers pronounced^ 
mucous membrane thick, presenting several permanent, trans- 
verse folds, plicae recti, or valves of Houston ; is supplied by 
superior, middle and inferior hemorrhoidal arteries; is be- 
hind bladder and prostate in male, and vagina in female. 

Where does the abdominal aorta commence and where 
does it terminate? 

Commences at aortic opening in diaphragm upon body of 
twelfth thoracic vertebra; terminates upon body of fourth 
lumbar vertebra, just to left of median line. 



ANATOMY. 555 

Where is the foramen ovale of the heart and what 
purpose does it serve? 

In the wall between the auricles ; permits passage of blood 
in the foetus from right to left auricle, deflecting its course 
from right ventricle and pulmonary circulation into general 
circulation. 

What are the lymphatic glands? 

Parts of lymphatic system consisting of adenoid tissue, 
enclosed in capsule, having afferent and efferent lymphatic 
vessels ; lymph passes through them. 

Describe the changes in the vascular system at birth. 

Blood ceases to flow through umbilical vein and ductus 
venosus into inferior cava; hypogastric arteries become ob- 
literated; foramen ovale closes and blood then does not pass 
from right to left auricle ; ductus arteriosus, connecting pul- 
monary artery with arch of aorta becomes impervious and 
pulmonary circulation is actively established. 

In the anatomy of the brain what is the corpus callosum? 
Describe its connections. 

The great transverse commissure consisting of fibers which 
pass from one hemisphere to the other, connecting different 
parts of the cortex of one with that of the other, is located 
nearer the base than the top and forms the roof of the lateral 
ventricles. 

When (i. e., at what time in life) do the epiphyses join 
the shaft? 

Lesser trochanter about 18th year, then greater trochanter, 
head, and lastly, at 20th year or later, the lower epiphysis 
(condyles). 

Mention a muscle (a) which moves the thumb outward, 
(b) which moves the head forward, (c) which moves the 
foot inward. 

(a) Abductor pollicis; (b) sterno-cleido-mastoid (rectus 
capitis anticus major) ; (c) tibialis anticus. 



556 ANATOMY. 

What are the functions of the trigeminus (fifth cranial) 
nerve? What are its general divisions? 

To supply the muscles of mastication with motor, and the 
tissues of the face with sensory, influence. Divisions are: 
ophthalmic, maxillary and mandibular. 

What is the composition of intervertebral substance? 
How much of the spinal column does this substance form? 

Is made up of fibro-cartilage ; constitutes about % of the 
spinal column. 

Give the boundaries of the anterior mediastinum. 

In front by the sternum, behind by the pericardium, later- 
ally by the pleurae. 

What are the ciliary processes in the eye? Where are 
they placed and what is their average number? 

Folds of middle tunic (uveal tract) consisting of con- 
nective tissue, blood vessels and pigment; are placed around 
periphery of lens close to edge, posteriorly, and number about 
seventy. 

State the action of each of the following muscles: 
masseter, tibialis anticus, gluteus maximus. 

Masseter, to bring lower jaw up against upper jaw; tibialia 
anticus, to flex foot upon leg and elevate and adduct inner 
border of foot ; gluteus maximus, to extend trunk upon thigh, 
or thigh upon trunk. 

Give a general description of the peritoneum. Name the 
principal organs covered by it. 

Is a closed sac (except in female, at orifices of Fallopian 
tubes) which lines abdomianl wall (parietal layer) and 
partially or completely surrounds viscera (visceral layer), 
constituting their serous coat; it forms omenta: gastro-colic, 
or great omentum, gastro-hepatic, or lesser omentum, and 
gastro-splenic ; it forms mesenteries: mesentery (proper), of 
small intestine, mesocolon (ascending, transverse, descending, 
sigmoid, mesoappendix) ; principal organs covered by peri- 



ANATOMY. 557 

toneum are: liver, stomach, spleen, small intestine,, large 
intestine, Fallopian tubes, uterus, bladder. 

Describe the thymus gland. 

Is first found during second month of intrauterine life, 
is largest when child is two or three years old, and usually 
disappears before puberty ; is located in anterior mediastinum 
and lower part of neck, between lungs, in front of heart 
and great vessels and trachea; consists of two lobes made up 
of lobules which are essentially lymphatic in character. 

What are the suprarenal capsules and what are their 
relations to adjacent organs and parts? 

Are two in number, one placed upon the upper pole of 
each kidney ; each consists of cortex and medulla with vessels 
entering and leaving at a hilum; cortex is yellowish in color 
and contains granular, polyhedral cells arranged in columns; 
medulla is darker in color, from presence of bloodvessels 
which are closely related to groups of large cells. Suprarenal 
bodies are partially covered by peritoneum and are in rela- 
tion, right with under surface of liver, left with spleen, 
stomach and pancreas. 

Describe the medulla oblongata. 

Is a part of encephalon, continuous with spinal cord be- 
low and with pons above; it rests upon basilar process of 
occipital bone, consists of white nerve matter externally 
and gray matter arranged irregularly internally, the latter 
appearing upon the surface in floor of fourth ventricle, the 
lower half of which is formed by upper surface of medulla; 
upon ventral surface is anterior median fissure, partially 
obliterated below by decussation of crossed pyramidal tracts ; 
near anterior part of inferior surface are olivary bodies; 
posterior columns diverge to form calamus scriptorius and to 
bound fourth ventricle laterally for its lower half; postero- 
laterally are restiform bodies which can be traced upward 
into cerebellum, forming inferior peduncles of latter. 
Cranial nerves from seventh to eleventh inclusive arise from 



558 ANATOMY. 

side of medulla, while twelfth appears upon surface in groove 
between olivary body and anterior pyramid. 

Locate and describe the lachrymal gland. 

Is located in upper, outer and anterior part of orbit, to 
inner side of external angular process ; is made up of lobules, 
or clusters of acini, arranged around the ducts, six to twelve 
in number, which empty into outer part of superior con- 
junctival fornix. 

Describe the lungs. 

Each is pyramidal in shape, base resting upon diaphragm, 
apex extending into superior aperture of thorax, lateral, con- 
vex surface being applied to thoracic wall and inner, mesial 
and irregularly concave surface looking toward mediastinum ; 
each possesses a root, placed upon inner surface, near pos- 
terior, thickened margin, and consisting of bronchus, pulmon- 
ary artery and vein, bronchial artery, nerves and lymphatics ; 
right lung has three lobes, left has two; each is made up of 
lobules consisting of a terminal bronchiole around which are 
arranged clusters of air cells ; each lung is invested by visceral 
layer of pleura, whose parietal layer lines thoracic wall. 

Describe the structure of the knee=joint. 

Bones: femur, tibia, patella; ligaments: internal and ex- 
ternal lateral, ligamentum patellae, posterior; these are 
strengthened and supported by aponeuroses of vastus externus 
and internal antero-laterally, semimembranosus posteriorly; 
chief internal ligaments are crucial, anterior and posterior; 
joint contains two semilunar cartilages which are attached to 
non-articular area upon upper surface of tibia ; synovial mem- 
brane is extensive and complicated; movements: flexion, ex- 
tension, slight rotation. 

Bound the popliteal space. Mention its contents. 

Above by outer and inner hamstrings, below by outer and 
inner heads of gastrocnemius muscle, with plantaris upon 
outer side; contents are: internal and external popliteal 



ANATOMY. 559 

nerves, polpiteal vein and popliteal artery, termination of 
short saphenous vein and small lymphatic glands. 

Mention the principal branches of the coeliac axis. 

Gastric, hepatic and splenic arteries. 
What are the nerves of the eyeball? 

Optic, motor oculi and ophthalmic division of fifth (both 
through ophthalmic ganglion) and sympathetic fibers from 
cavernous plexus (also to ganglion). 

Describe the aural labyrinth. 

Osseous labyrinth, whose divisions are three semicircular 
canals posteriorly placed, a vestibule in middle, and cochlea 
anteriorly, all containing membranous labyrinth upon which 
terminal filaments of auditory nerve and its special neuro- 
epithelium are found. 

Describe the popliteal artery and give its branches. 

Is a continuation downward of femoral from opening in ad- 
ductor magnus and divides at lower border of popliteus 
muscles into anterior and posterior tibial arteries ; it lies upon 
femur, posterior ligament of knee-joint, tibia, and fascia cov- 
ering popliteus muscle; it enters popliteal space at upper 
inner margin, and bisects it longitudinally; popliteal vein 
is superficial to it ; branches are superior and inferior internal 
and external articular, azygos articular, sural (muscular Ho 
calf) , and anterior and posterior tibial. 

What are the bloodvessels which supply the arteries 
called? Whence are the nerves of the arteries derived? 

(a) Vasa vasorum. (b) Vasomotor, from sympathetic 
system. 



PHYSIOLOGY. 



Explain the physiological circuit essential to a reflex 
action. 

The essentials are an afferent nerve, a nerve center, an 
efferent nerve and the peripheral organ which it supplies. 

Mechanical irritation of the sensory fibers of the vagus in 
the mucous membrane of the stomach causes an increased 
flow of saliva by irritation of the salivary center in the 
medulla and consequent passage of efferent impulses to the 
salivary glands. 

What is the function of the sixth (abducens) nerve? 

The abducens is the motor nerve of the external rectus. 

Describe the respiratory function of the red blood cor- 
puscles. 

When the venous blood reaches the capillaries sur- 
rounding the air vesicles of the lung, the hemoglobin found 
in the red corpuscles rapidly combines with the absorbed 
oxygen to form oxyhemoglobin. This is carried back to the 
heart and then into the systemic circulation, finally reaching 
the capillaries. Here the tissues take the oxygen from the 
loosely combined oxyhemoglobin. The hemoglobin is then 
carried back to the lungs to be reoxygenated. The cor- 
puscles also carry small amounts of carbon-dioxide from the 
tissues to the lungs. 

Describe the normal pulse; state the factors active in its 
maintenance, and give the average rate during infancy, 
youth and adult age. 

The pulse is the transmission of the cardiac impulse through- 

(561) 
36 



562 PHYSIOLOGY. 

out the arterial system. A normal pulse should be full, of 
moderate tension, regular and of the right frequency. It is 
ordinarily examined over the radial artery at the wrist, 
because in this position there is a hard surface against which 
we can press the artery. 

The factors active in its maintenance are the normal action 
of the heart and of the vasomotor system. 

The average rate during infancy is 130 to 140; during 
youth 80 to 90 ; during adult life 70 to 75. 

Name the active principles of the digestive secretions 
and state how each affects the food. 

Ptyalin of saliva changes starch into maltose. 

Pepsin, when hydrochloric acid is present, changes pro- 
teids into peptones. 

Rennin changes caseinogen into casein. 

Amylopsin changes starch into maltose. 

Steapsin splits up fat into fatty acid and glycerin. 

Trypsin, in an alkaline medium, changes proteids into 
peptones. 

Invertin changes maltose into dextrose, and saccharose 
into equal parts of dextrose and levulose. 

Bile contains no ferment, but aids the pancreatic secretion 
in the emulsification of fats. 

From what portions of the cortex cerebri do the arm, 
face and leg receive their motor impulses? 

The motor area is along the fissure of Rolando in the as- 
cending frontal, ascending parietal and paracentral convolu- 
tions. The leg center is the uppermost, the arm center next, 
and the face center the lowermost. 

Describe the position of the vocal cords during phona- 
tion and name the factors concerned. 

The chink of the glottis during phonation is narrowed, 
the arytenoid cartilages are approximated and the vocal cords 
are stretched. The arytenoid muscle approximates the ary- 
tenoid cartilages, and with the help of the lateral crico-ary- 



PHYSIOLOGY. 563 

tenoids and the internal part of the thyro-arytenoids closes 
the glottis. The vocal cords are made tense by the crico- 
thyroids and external part of the thyro-arytenoids. 

Give the origin of normal fat in the human body and 
name examples of the types of food from which it is 
elaborated. 

The normal fat of the body is derived from food ingested. 
Any excess of food is stored np as fat. Fat may be elabor- 
ated from fats ingested as olein, from carbohydrates as starch, 
or from proteids as casein. 

Describe a complete physiological revolution of the 
heart. 

During diastole the blood from the auricles passes into 
the ventricles. Toward the end of diastole the auricles 
contract, forcing the blood remaining in them into their 
respective ventricles ; the ventricles now contract, the auriculo 
ventricular valves are closed and the blood is forced into the 
pulmonary artery and aorta through the open semilunar 
valves; the ventricles now relax, the semilunar valves clos- 
ing with a snap and the auriculo ventricular valves being 
opened by the force of blood in the auricles and by the nega- 
tive pressure in the ventricles. 

If the cardiac revolution were divided into tenths, the first 
or systolic sound would occupy four-tenths, the short silence 
one-tenth, the second or diastolic sound two-tenths, and the 
long silence three-tenths. 

Describe the process of respiration. 

Respiration is the function of taking in oxygen and the 
throwing off carbon dioxide. This exchange of gases takes 
place in the air vesicles where the blood and atmospheric air 
are separated by but a single layer of squamous epithelium. 

Three factors are concerned in this exchange — the law of 
pressure of gases, chemical affinity, and the vital activity 
of the epithelium. 

In tissue respiration the oxygen passes through the endo- 



564 PHYSIOLOGY. 

thelium forming the capillary wall, into the tissue, where it is 
used up. The carbon dioxide so formed passes from the tis- 
sues into the capillaries and thence to the lungs. 

What are the functions of the blood vessels? 

Through the bloodvessels the blood is forced to the various 
parts of the body, carrying nutritive products to the tissues 
and waste from the tissues to the organs that excrete it. By 
their muscular wall they regulate the amount of blood going 
to various portions of the body, and together with the elastic 
tissue they contain also reduce the amount of work thrown on 
the heart. Through the capillary wall osmosis and diape- 
desis take place. 

Name and describe the normal respiratory sounds of the 
lungs and bronchi. 

The vesicular sound is a distant, soft, breezy sound, of 
low pitch, with the inspiration three or four times longer 
than expiration. It is caused by air passing through the 
bronchi, the sound being modified by the air vesicles. The 
bronchial sound is caused by -the air rushing in and out of 
the bronchi. It is high pitched, loud, tubular in quality, the 
expiration being to inspiration as seven is to six. 

Of the functions of vision, what is understood by ac- 
commodation? 

By accommodation is meant the increasing of the curvature 
of the anterior surface of the crystalline lens to focus near 
objects on the retina. 

Describe the action of the kidneys, and give the normal 
constituents of the urine. 

The kidneys are compound tubular glands that pick out 
from blood certain waste material which passes down the 
tubules into the pelvis of the kidneys and then into the 
bladder. 

But one constituent of the urine is formed in the kidney 
and that is hippuric acid. 

The water filters through the glomeruli principally, while 



PHYSIOLOGY. 565 

the urea is picked out by the rodded epithelium of the con- 
voluted tubules. No proper secretory nerves have as yet been 
found for the kidneys, which seem rather to be controlled by 
the vasomotor system. The kidneys have possibly an in- 
ternal secretion also. 

The normal constituents of the urine are — water, urea, 
uric acid, hippuric acid, sodium chloride, potassium and 
sodium sulphates, conjugate sulphate as indican, earthy and 
alkaline phosphates, sometimes carbonates and oxalates, and 
the coloring matters urochrome, urobilin and uroerythrin. 

Describe gastric digestion, with special reference to the 
changes effected upon the types of food. 

When the food reaches the stomach the two openings close 
and the involuntary muscle contracts down on the mass and 
starts up a churning-like movement, by which fresh portions 
of food are constantly brought to the surface. At the end 
of an hour the pyloric orifice gradually relaxes, allowing some 
of the more liquid chyme to pass into the duodenum, and by 
the end of three or four hours even the larger pieces of un- 
digested food are forced into the duodenum. During this 
time the gastric juice is being poured out from the mucous 
membrane. The act of mastication and deglutition and the 
irritation of sensory vagi endings in the stomach by the food 
act as powerful reflex excitants to this secretion. 

The ptyalin of the saliva continues to change starch into 
maltose until the increasing acidity of the gastric juice stops 
its action. 

The fats are liquified, but it is upon the proteids that the 
chief action takes place. The rennin changes caseinogen 
into casein. The pepsin in the presence of the hydrochloric 
acid changes the proteids into proteoses and peptones. 

Describe the process of segmentation of the ovum. 

The impregnated ovum first divides into two cells by in- 
direct division or karyokinesis, these again subdivide, con- 
tinuing until finally a single layer of cells surrounding a 
central cavity is formed. One group of cells proliferates 



566 PHYSIOLOGY. 

more rapidly than the other and as a result they become sur- 
rounded by the other layer; thus two leaves are formed. 
Between these a third layer or mesoblast is formed. From 
this blastoderm the animal is now developed. 

What is the relation of the capillaries to the circulation? 

The capillaries connect the small arterioles with the small- 
est veins. They are situated at the periphery. 

What precautions should be taken in the ingestion of 
vegetable foods? Give the reasons for taking these 
precautions. 

Vegetable foods should be well cooked so as to burst the 
cellulose covering of the starch granules; they should be 
well chewed so as to break up the cellulose covering. Some 
fatty food should be taken with them as they are deficient 
in fats. As some of them contain but little nutritive ma- 
terial, they should be taken in large quantities for obvious 
reasons. 

Describe the process of osmosis and give examples in 
the human economy. 

Osmosis is the diffusion of liquids through a porous mem- 
brane. 

For osmosis to take place the liquids must be miscible, of 
different natures, capable of wetting the membrane without 
acting on it chemically, and the substance must be able to 
pass through the membrane, that is be crystalloidal in nature. 
Heat, increase of pressure and electricity aid osmosis. 

The following are examples of osmosis: (1) The passage 
of some of the plasma through the capillary wall into the 
tissues. (2) The passage of glucose from the intestine into 
the portal circulation. 

Name the secretions of the alimentary canal and give 
the functions of each. 

Saliva changes starch into maltose, dissolves soluble sub- 
stances thus allowing them to be tasted, lubricates the bolus 
of food and aids in speech. 



PHYSIOLOGY. 567 

Gastric juice changes easeinogen into .casein, and proteids 
into proteoses and peptones. It also destroys many micro- 
organisms swallowed in the food. 

Pancreatic secretion changes proteids into peptones, starch 
into maltose, easeinogen into casein, and splits up, saponifies 
and emulsifies fats. 

Bile neutralizes the acid chyme precipitating the pepsin, 
aids in the emulsification and absorption of fats, increases 
peristalsis, prevents excessive putrefaction, and contains some 
waste thrown off by the liver. 

Succus entericus changes maltose into glucose, and sac- 
charose into invert sugar. 

The alimentary canal has also the usual protecting and 
lubricating secretion of mucus. 

Describe urea, its occurrence, variations in the quantity 
excreted and recognition in the voided urine. 

Urea, CO(NH 2 ) 2 , the great nitrogenous waste, is a crystal- 
lizable substance soluble in alcohol and water, neutral in 
reaction and forming with nitric acid urea nitrate. About 
500 grains daily are thrown off in the urine by the kidneys. 
It is formed in the liver ( f ) and in the intestines ( \ ) . It 
varies principally with the amount of nitrogenous food in the 
diet. Muscular exercise does not increase it to any marked 
extent. It is recognized by adding nitric acid to a concen- 
trated urine when urea nitrate separates out in a crystalline 
mass, also by the hypobromite test. 

What is rigor mortis? What is tetanus? 

Rigor mortis is the post-mortem rigidity of the muscles due 
to the coagulation of the myosinogen. 

Tetanus is a state of continued contraction of a living 
muscle. 

Give the varied functions of the sympathetic nerve. 

The function of the sympathetic system is mainly vaso- 
motor. It also supplies the heart with accelerating fibers, 
the intestines with inhibitory and some motor fibers; dilates 



568 PHYSIOLOGY. 

the pupil, and causes a bulging of the eyeball. It also has 
an influence on the salivary secretion. 

How are the phenomena of ventriloquism produced? 

Instead of the usual expiratory blast, an inspiratory blast 
is used in producing the vocal sounds. At the same time 
the operator directs the attention of the onlookers to some 
object. 

Describe the mechanism of micturition. 

Usually it is a mixture of a voluntary and involuntary re- 
flex act. The reflex center is situated in the lumbar cord. 
Stimulation of this center is ordinarily caused by a full 
bladder or by the escape of a drop of urine into the urethra, 
but may be excited by irritation of sensory nerves of other 
surfaces, as the intestinal mucous membrane by worms. 
Ordinarily the sphincter of the bladder is inhibited, the 
muscular wall contracts, and aided by the abdominal and 
other expiratory muscles forces the urine out through the 
urethra. There are higher centers that have control over 
the lower reflex centers. 

Name the ferments that are the essential constituents 
of each digestive fluid. 

Ptyalin is found in saliva; pepsin and rennin in gastric 
juice; amylopsin, steapsin, trypsin and a milk-curdling fer- 
ment in the pancreatic juice ; invertin in the succus entericus ; 
and the micro-organisms or organized ferments in the in- 
testines. Bile contains no ferment. 

What are the functions of the spinal cord? 

The spinal cord is the great motor and sensory pathway 
to and from the periphery. In the anterior horns are found 
the cells concerned in the muscular reflexes, and also the 
trophic centers for the muscles. Beside the muscular reflex 
centers, the cord contains the following centers: anospinal, 
vesicospinal, genitospinal, uterospinal, sweat, minor vaso- 
motor and possibly ciliospinal. 



PHYSIOLOGY. 569 

What postmortem tests should be applied to prove that 
air has entered the lungs of a supposedly still=born child? 

Tie the trachea, take out the lungs and place them in 
water. If they float air has entered the lungs. The thorax 
is not as flat after respiration has started and the diaphragm 
is displaced further downward. The lungs are brighter in 
color and are crepitant after air has once entered. 

Wherein does the temperature of the body in advanced 
age differ from its temperature in middle life? 

In advanced age the temperature has a tendency to be- 
come subnormal from the slightest cause. 

Give in language or by drawing the sphygmographic 
tracing in aortic insufficiency. 

In aortic insufficiency there is the so-called " trip hammer 
pulse." In the sphygmogram there is a very high, quick up 
stroke and an almost as quick downstroke due to the rapid 
decrease in pressure caused by the regurgitation. On the 
downstroke a small dicrotic wave is seen. 

What are amyloid foods, proteid foods? Give three ex- 
amples of each. 

The amyloid foods are the carbohydrates in the molecule 
of which are six or multiple of six atoms of carbon, and 
hydrogen and oxygen in the proportion to form water. 
Starch, cane sugar and glycogen are amyloids. 

Proteids are highly complex bodies containing carbon, 
hydrogen, oxygen, nitrogen, sulphur and sometimes phos- 
phorus. Egg albumen, casein and gluten are proteids. 

How is cartilage (a) developed, (b) nourished? 

Cartilage is developed from the mesoblast. The cells are 
not branched. By karyokinetic changes they divide and 
subdivide. Each cell is surrounded by a capsule which helps 
to form a portion of the matrix. But beside this, other 
material is deposited in the intercellular spaces. 

Cartilage is nourished by the perichondrium except arti- 
cular cartilage, which is nourished from the underlying bone. 



570 PHYSIOLOGY. 

Describe nerve cells and nerve fibers. 

The nerve cells are nucleated masses of agranular proto- 
plasm with one or more protoplasmic prolongations called 
dendrons. Passing off from most nerve cells is a long fiber 
or axis cylinder. 

The nerve fibers are either medullated or non medullated. 
The medullated fibers consist of an axis cylinder or neur- 
axon, surrounded by the myelin or white substance of 
Schwann, which in turn is covered with the neurilemma or 
sheath of Schwann. An internal layer of protoplasm separ- 
ates the myelin from the neuraxon, and an external layer 
separates the myelin from the neurilemma. Here and there 
along the course of the nerve are found the nodes of Ranvier. 
The non-medullated fibers contain no myelin. 

What experiments have been made to prove the glyco= 
genie function of the liver? 

The blood of the portal vein during active digestion of a 
carbohydrate meal contains more sugar than the hepatic 
vein showing the arrest of dextrose in the liver. The hepatic 
vein in the intervals of digestion contains twice as much 
dextrose as that in the blood entering the liver. 

If a rabbit that has been feed on carrots is killed and the 
liver rapidly removed, cut into small pieces and thrown into 
boiling water, it yields an extract rich in glycogen and al- 
most free of dextrose. 

If another animal is treated the same but the liver al- 
lowed to stand for some time before making an extract, the 
extract will contain much dextrose and but little glycogen. 

The carbohydrate of blood is dextrose and not glycogen. 
Under the microscope, glycogen granules are found in the 
protoplasm of the liver cells. 

In what glands of the body is the function undetermined? 

With the exception of being able to say that they are all 
probably connected with general metabolism, the functions 
of the following glands are undetermined: pituitary body, 



PHYSIOLOGY. 571 

thymus, coccygeal gland. But little is known about the 
adrenals, and thyroids. 

What is the normal ratio of respirations to heart pul= 
sation? 

In a healthy adult there are four pulse beats to ocie re- 
spiration. 

Give the foramen of exit, the distribution and the 
function of the oculomotor nerve. 

The oculomotor nerve leaves the skull through sphenoidal 
fissure. It supplies motor filaments to the superior, in- 
ternal and inferior recti, the inferior oblique, the levator 
palpebrae, the ciliary muscle and the constricting fibers of 
the iris. 

What office does the Eustachian tube perform? 

It equalizes the pressure of the air on the membrana- 
tympani, thus facilitating hearing. 

Define leucomain, ptomain. 

Leucomains are alkaloidal or basic substances formed in 
the living tissue by metabolism, waste in nature, some of 
them toxic. 

Ptomains are alkaloidal substances produced by putrefac- 
tion of animal or vegetable matter. 

Give the present physiologic conclusions in respect to 
the presence of the corpus luteum as a sign of pregnancy. 

According to Tidy, " there may be pregnancy without the 
presence of a true corpus luteum, and also bodies indis- 
tinguishable from true corpora lutea may be found where 
there has been no pregnancy." The presence of the true 
corpus luteum nevertheless is usually a sign of pregnancy. 

What effects are produced in the system by the removal 
of the thyroid gland? 

Removal of the thyroid gland is followed by peculiar de- 
praved condition of metabolism called cachexia strumipriva. 



572 PHYSIOLOGY. 

Give the principal characteristics of gastric juice in man. 

Gastric juice is an acid limpid secretion with a specific 
gravity of about 1005, quantity ten pints daily. It contains 
especially pepsin, rennin and hydrochloric acid. 

How can fresh blood stains be distinguished from older 
blood stains? 

Fresh blood stains are brighter in color and the clot is 
flexible; the older stain is darker and the clot is fragile. 

Describe color blindness and name the colors which the 
subject commonly fails to distinguish. 

Color blindness is the inability to perceive certain colors. 
The colors commonly indistinguishable are red and green. 

What are the functions of the brain membranes? 

The dura mater is tough and protecting; and also acts as 
internal periosteum to the bones of the head. 

The arachnoid is a thin spider4ike membrane covered 
with endothelial cells that secrete cerebrospinal fluid. 

The pia mater is a vascular membrane dipping down into 
the sulci and carrying blood to the cortex. 

Name the solids in the urine and state the approximate 
amount of each voided daily by an adult. 

Urea 500 grains ; chloride of sodium 180 grains; sulphates 
(sodium and potassium) 30 grains; phosphate (earthy and 
alkaline) 45 grains; uric acid 7 grains; hippuric acid 7 
grains; and small quantities of various pigments and other 
organic matter. 

Describe the factors which cause the heart sounds. 

The first sound is due to the sound of muscular contraction 
and to the closure of the auriculo ventricular valves, as the 
blood tends to regurgitate into the auricles during ventri- 
cular systole. 

The second sound is due to the closure of the semilunar 
valves, as caused by the blood tending to regurgitate into 
the ventricles during diastole. 



PHYSIOLOGY. 573 

What is the effect of an excessive meat diet? 

An excessive meat diet disturbs the general metabolism, 
causing diseased conditions associated with an increase in 
uric acid, as gout, rheumatism and migraine. 

Explain how the seminal fluid is conveyed to the vesi= 
culae seminales. 

It is conveyed to the vesiculae seminales by the vas deferens 
which is the prolongation of the tube forming the epididymis. 
The vas deferens passes up from the testicles through the 
external and internal abdominal rings and to the vesiculae 
seminales on the posterior surface of the bladder. 

How and why is hearing affected by rupture of the mem= 
brana tympani? 

The membrana tympani, on account of its shape and the 
action of the tensor tympani, is capable of responding to 
many vibrations, and thus aids in the acuity of hearing. 

Describe cell growth. 

Cell growth is that peculiarity which living cells have of 
taking in new material and incorporating it into themselves, 
thus increasing in size. 

Describe the phenomena of (a) asphyxia, (b) syncope, 
(c) sleep. 

Asphyxia is the condition caused by a deficient supply of 
oxygen. In the complete shutting off of the supply of 
oxygen we have three stages. First, the stage of marked in- 
spiratory efforts or dyspnoea, lasting about one minute; 
second, the stage of convulsions with marked expiratory 
spasms, lasting about one minute ; and third, the stage of ex- 
haustion and finally death. 

During the first stage the blood pressure begins to rise and 
heart becomes somewhat slower. During the second stage 
this rise in blood pressure is well marked and also the slow- 
ing of the heart. Toward the end of this stage as the re- 
spiratory movements cease unconsciousness ensues, the blood 



574 PHYSIOLOGY. 

pressure falls and the heart becomes still slower, until death 
stops everything. 

Syncope is that condition of unconsciousness following a 
sudden depression of the vasomotor and cardiac nervous 
mechanism, causing anaemia of the brain. 

Sleep is a physiological condition of unconsciousness, due 
to a periodical need of the nervous system of rest. It is 
also due in part to the absence of external stimuli. It is ac- 
companied by an anaemia of the brain. 

Name, locate, and give the function of each of the 
varieties of epithelia. 

Epithelium secretes and protects the underlying tissues. 
Squamous epithelium, found in the mouth, protects the under- 
lying structures. Columnar epithelium, found in the intes- 
tinal mucosa, aids in the absorption of digested food products. 
Ciliated epithelium, found in the bronchial mucosa, forces 
dust and mucus up into the trachea to be coughed out. 
Cuboidal epithelium, found in the salivary glands, secretes 
saliva. Groblet-shaped epithelium, found in the mucous mem- 
branes, forms the mucous secretion. Stratified epithelium is 
composed of several layers, the uppermost generally squa- 
mous, and lowermost columnar. It forms the epidermis. 

Describe the lymphatic system. 

The lymphatic system consists of numerous small thin- 
walled vessels with many valves, commencing in the tissues 
as lymph capillaries and emptying into two large vessels 
that carry the contained lymph to the subclavian veins. In 
certain places along the course of the lymphatics, as in 
axilla and groin, are found groups of little glands called 
lymphatic glands. These consists of a cortical portion and 
a medulla which is made of lymphoid tissue, in the center of 
which are a number of cells rapidly undergoing karyokinesis. 

All the lymphatics (including the lacteals of the intestine) 
with the exception of right half of the body from the dia- 
phragm upward, empty into the thoracic duct. This vessel, 



PHYSIOLOGY. 575 

about the diameter of a goose quill, empties into the left 
subclavian vein. The lymphatics of the right side of the 
body from the diaphragm upward empty through a smaller 
vessel into the right subclavian vein. 

Describe the olfactory apparatus. What part of the 
olfactory apparatus is the seat of smell? 

The nasal cavities are divided into a lower or respiratory 
portion and an upper or olfactory portion. 

We find in the upper portion some broad supporting epithe- 
lial cells, and projecting upward from cells between these 
are little hair-like processes. The olfactory nerve ends in 
these specialized cells. The olfactory nerve passes from these 
cells through the olfactory bulbs and backward through three 
tracts to the cerebrum, ending for the most part in the uncus 
of the same side. 

What is the physiology of the so=called rest cure? 

The rest cure corrects faulty metabolism and brings the 
tissues again to their normal conditions. 

How is the descent of the testicle to the scrotum ac= 
complished? 

The descent of the testicle is now generally thought to be 
due simply to the arrangement of the organs due to the 
process of development and not to the traction of muscular 
cord as formerly thought. 

Describe the growth and the development of the teeth. 

The first step in the formation of the teeth is the down- 
ward growth of the epithelium covering the rudimentary jaw. 
This forms the enamel germ, which develops especially at cer- 
tain points. A little vascular papilla now grows upward 
into this enamel germ; thus we have the rudimentary teeth. 
The adamantoblasts of the enamel germ form the enamel, and 
the odontoblasts form the dentine which covers in the dental 
pulp. The crusta petrosa is formed from the cells forming 
the dental periosteum. 



576 PHYSIOLOGY. 

What is the condition of the eyeball in myopia? How 
may it be corrected? 

In myopia the eyeball is too deep, causing the rays of 
light to be brought to a focus in front of the retina. It is 
corrected by a concave lens. 

Define physiologically the term cell. How are cells 
reproduced? 

A cell is a nucleated mass of protoplasm. 
Cells are reproduced by direct division, indirect division 
or karyokinesis, and endogenous nuclear multiplication. 

Describe the physical characteristics of cartilage. What 
is temporary cartilage, permanent cartilage? Illustrate. 

Cartilage is a firm, elastic, white or yellowish-white sub- 
stance. 

Temporary cartilage is that which afterward is formed 
into bone, as the foetal femur. 

Permanent cartilage is that which remains as cartilage dur- 
ing life, as articular cartilage. 

Describe the white blood corpuscles, giving source, com= 
position and properties. 

The white blood corpuscles are nucleated masses of granu- 
lar protoplasm, about ysVo" i n « i n diameter and capable of 
amoeboid movement and phagocytic action. 

As to the varieties, we find the small lymphocyte, the larger 
transitional, the polymorpho nuclear, and eosinophile con- 
taining large granules staining readily with eosin. Occas- 
ionally a basophile can be found. 

The white cells are developed from the lymphatic tissues, 
the spleen and the marrow of bone. Chemically they con- 
tain nuclein, a globulin, fat, glycogen and a nucleoproteid. 

What changes are produced in the air and in the blood 
by respiration? 

The expired air contains less oxygen and more carbon 
dioxide, nitrogen, and water than inspired air. It also con- 



PHYSIOLOGY. mi 

tains certain volatile organic substances and is warmer than 
the inspired air. 

The blood leaving the lungs contains more oxygen and less 
carbon dioxide and nitrogen than that entering the lungs. 

Define aphonia, aphasia. Give the cause of one of these 
conditions. 

Aphonia is the loss of voice, or the power of phonation. 
Aphasia is the inability to give the proper word symbol. 
Motor aphasia is due to a lesion of the left lower frontal 
convolution or of the fibers coming from it. 

Describe the normal heart sounds. 

The first sound is twice as long as the second, lower in 
pitch and with a prolonged dull somewhat booming quality. 
It is caused by the closure of the auriculoventricular valves 
and the sound of contracting muscular walls of the ventricles. 
It is heard best at the apex, and is systolic in time. 

The second sound follows the first after a short interval. 
It is short, snapping in quality and is higher pitched than 
the first. It is caused by the closure of the semilunar valves 
and is diastolic in time. It is heard best at the base of the 
heart. 

State the physiologic uses of the large intestine. 

Into the large intestine the crypts of Lieberkuhn pour in 
some secretion and the microbic digestion goes on. Although 
no villi are found here part of the food not already absorbed 
is taken up. The feces are concentrated and collected in the 
lower end of the intestine to be expelled during the act of de- 
fecation. 

Define (a) tonic muscular contraction, (b) clonic muscu- 
lar contraction. Give an example of each. 

Tonic muscular contraction is a continued contraction, as 
the action of sphincter ani. 

Clonic muscular contraction is an intermittent or remittent 
muscular contraction as seen in the jerking movements of a 
convulsion. 
37 



578 PEY8I0L0GY. 

Give the origin and uses of lymph. 

Lymph is a diluted blood plasma that has osmosed from 
the capillaries. The cells formed in the lymphatic glands 
are added to this during its passage through the glands. 

The lymph supplies nourishment to the tissues, carries away 
waste matter from the tissues; in the intestinal wall and 
mesentery it contains the absorbed fat and is here called 
chyle. It also carries into the blood the products of some 
-of the ductless glands, as the thyroid. 

Define reserve air, residual air, complemental air, tidal 
air. 

Reserve air is the amount of air that can be expired after 
an ordinary expiration, about 100 cubic inches. 

Residual air is the amount of air left in the lungs after 
the most forcible expiration, about 100 cubic inches. 

Complemental air is the amount of air that can be taken in 
after an ordinary inspiration, about 100 cubic inches. 

Tidal air is the amount of air taken in with each ordinary 
inspiration, about 30 cubic inches. 

What are the respective functions of the anterior and 
of the posterior cornua of the spinal cord? 

The anterior cornua are motor in functions and are the 
trophic centers for the muscles. 

The posterior cornua are mostly relay stations on the sen- 
sory pathway. 

What explanation may be given for enlargement of the 
spleen in leucocythemia? 

The spleen is one of the organs in which white corpuscles 
are formed. 

Give the difference between the temperature of a new= 
born child and that of an adult, between the temperature 
of a person intoxicated by alcoholic drink and his tern- 
perature after the first stimulating drink of liquor. 

Immediately after birth the temperature is somewhat above 



PHYSIOLOGY. 579 

normal but soon becomes subnormal. At the end of twenty- 
four hours it has again reached normal and remains so. A 
small dose of alcohol causes a slight rise in temperature; 
large doses, as in one intoxicated, cause a subnormal 
temperature. 

In a healthy man, what time is consumed in the diges- 
tion of an ordinary meal of meat, vegetables and bread? 

The food remains from two to four hours in the stomach 
and about six hours in the small intestine. Digestion is 
practically finished before it leaves the small intestine. 

Define human physiology. 

Human physiology is the study of the phenomena of the 
Jiving human body. 

Give the causes of muscular fatigue. 

Muscular fatigue is caused by the accumulation of waste 
products in the muscles. 

The seat of fatigue, as we ordinarily speak of it, is first in 
the central nervous system, then in the motor end plates, 
then the muscle and finally the nerve trunks. 

What effect is produced on the heart's action by stimu- 
lation of the cardioinhibitory center? 

There is a slowing of the heart, or, if the stimulus is great 
enough, a stoppage of the heart in diastole. 

Why does blood remain fluid in the body in life, and 
coagulates when shed? 

The intima has some unknown peculiar action on the blood. 
The blood does not clot until the disintegration of the 
white corpuscles sets free the fibrin ferment. 

What conditions produce variations in the normal tem- 
perature of the body? 

Anything that will disturb the proper balance of heat pro- 
duction and heat dissipation will cause a variation from the 
normal temperature. 



580 PHYSIOLOGY. 

Normal physiological variations are caused by digestion, 
muscular exercise, menstruation, bathing and excitement. 

Drugs, as cocain, atropine, alcohol, acentanilid, may cause 
variations from the normal; as will also hypodermic in- 
jections of proteoses and peptones, shock, toxins of bacteria 
and exposure to excessive changes in temperature of at- 
mosphere. 

Give the nervous mechanism of urination. 

The bladder is supplied with nerves from the lower dorsal 
and upper lumbar nerves and also with branches from the 
sympathetic system. The act of urination may be completely 
involuntary, the reflex center being in the lumbar portion 
of the spinal cord and set in action by afferent impulses 
from a distended bladder or from irritation possibly of the 
mucous membranes. Ordinarily the abdominal muscles aid 
voluntarily in urination. 

There is probably a higher voluntary center and also an 
inhibitory one. 

What are the functions of epithelium? 

Epithelium secretes and protects. 
Describe the human blood. 

Blood is a red, alkaline fluid, salty and nauseating in taste, 
with a peculiar odor. It has a specific gravity of about 1055. 
It is composed of a liquid portion called plasma, and a solid 
portion, the red and white corpuscles. In the plasma we 
find serum albumin and globulin, fibrinogen, various salts 
especially sodium, potassium and calcium, and small quan- 
tities of dextrose, fats and extractives. The hemoglobin is 
found in the red corpuscles. 

What is the purpose of respiration? Give the mechan- 
ism of respiration. 

During the act of respiration oxygen is absorbed and car- 
bon dioxide is thrown off. 

During inspiration the diaphragm descends, the ribs are 
elevated and rotated outward; the cavity of the thorax is 



PHYSIOLOGY. 581 

thus enlarged and the air rushes in to fill up the partial 
vacuum ; the muscles now relax and the elasticity of the chest 
wall and lungs forces a portion of the air out. These move- 
ments are controlled by the respiration center in the medulla. 

Describe the bile=producing and the glycogenic function 
of the liver. 

Bile is produced by the activity of the liver cells chiefly 
from the blood from the portal vein. It is collected in little 
canals hollowed between the cells and emptied into the bile 
capillaries. Through these it is forced on into the bile duct 
and either passed on into the duodenum during the act of 
digestion, or stored in the gall bladder until needed. 

Glycogen or animal starch is formed by the protoplasmic 
activity of the liver cells from proteids and carbohydrates. 
It is deposited in the liver cells and when needed is changed 
into dextrose by a diastatic ferment found in the blood of 
the liver. This dextrose is carried out in the blood of the 
hepatic vein into the general circulation. 

Give a dietary for people beyond the age of sixty years. 

Food for the aged should be readily digestible and capable 
of being easily burned up for the maintenance of the heat 
of the body. Among these articles are eggs, milk, rice, prop- 
erly cooked beef, butter and bread. 

What is the function of the cerebellum? 

The function of the cerebellum is the co-ordination of 
muscular movements. 

Describe ciliated epithelium and state where it is found 
most abundantly. 

The cells of ciliated epithelium are generally columnar in 
shape with numerous fine filaments projecting from their free 
surface. Ciliated epithelium is found most abundantly in the 
trachea and bronchi and here sweeps the mucus and small 
dirt particles toward the mouth. 



582 PHYSIOLOGY. 

Give a description of the act of deglutition and mention 
the muscles brought into action in swallowing. 

The swallowing of solids is divided into three stages, — 
buccal, pharyngeal and oesophageal. The first is voluntary, 
the others involuntary. The food is formed into a bolus and 
pressed backward by the tongue into the pharynx; the nasal 
cavities being closed, the pharyngeal muscles contract and 
force it on down to the oesophagus. This in turn contracts 
and by a peristaltic movement forces the bolus into the 
stomach. 

Liquids are not swallowed in this way, but are squirted 
down the oesophagus, with a bulb syringe effect, by the 
mylohyoid muscle. The muscles involved in deglutition are 
the mylohyoid, muscles of the tongue, pharyngeal muscles, 
especially the constrictors and the involuntary muscular 
fibers of the oesophagus. 

How is asphyxia produced? What are the causes of 
death from asphyxia? 

It is produced by anything causing a deficiency in the 
supply of oxygen to the tissues as oedema of lungs, membran- 
ous laryngitis, constriction of the trachea. 

Death is caused by a deficiency in the amount of oxygen 
and the accumulation of carbon dioxide in the blood. The 
respiratory center is probably the first one to be disabled. 

Describe (a) chyme, (b) chyle. 

Chyme is the acid semi-fluid mass of partially digested food 
passing from the stomach into the duodenum. 

Chyle is the lymph found in the lacteals of the intestines 
containing the absorbed fat. It is a milky white, alkaline 
fluid. 

Give the process of coagulation of blood. 

The fibrin ferment formed by the disintegration of the 
white corpuscles in the shed blood acts upon the fibrinogen 
and converts it, if calcium salts are present, into the insol- 
uble fibrin. The fibrin is formed in little filaments all 



PHYSIOLOGY. 583 

through the blood and immeshes the blood corpuscles. This 
forms the clot which gradually begins to contract. A liquid 
called serum soon exudes and collects over the clot. 

How is bone nourished? 

Bone is nourished by the nutrient arteries through the 
Haversian system of canals and by the periosteum. 

State the function of the anterior spinal nerve roots. 
How is the function proved? 

The anterior roots are motor. 

Section of the anterior roots causes motor paralysis of 
the parts that they supply. Irritation of the peripheral ends 
causes contraction of the muscles they supply. Irritation of 
central ends has no effect, no sensation is felt. 

Give illustrations of morbid reflex action. 

The vomiting of pregnancy is caused renexly by irrita- 
tion of mucous membrane of uterus. 

Faulty digestion may cause renexly palpitation of the 
heart. 

What is the composition of urine? Give the normal 
reaction and specific gravity of urine. 

Urine is composed of 96% water and 4% solids, one-half of 
which is urea. The other half is made up of phosphates 
(earthy and alkaline), sulphates of sodium and potassium, 
chloride of sodium, uric acid, hippuric acid, extractives and 
the coloring matters — indican, urobilin and urochrome. 

The normal reaction of urine is acid and the specific grav- 
ity 1020. 

Describe the temporary and permanent teeth. 

The temporary or milk teeth are twenty in number, ten in 
each jaw. From the front backward we have in each side 
of the jaw two incisors, one canine and two molars. The 
first tooth to erupt is the lower central incisor about the sixth 
month. This set is complete about the thirtieth month. 
About the sixth year the jaw has enlarged considerably; as 



584 PHYSIOLOGY. 

a result there is room for another tooth and the first per- 
manent tooth, the six year molar, erupts. Then the incisors 
are erupted, pushing out in front of them the temporary 
teeth. The last permanent tooth to erupt is the third molar 
or wisdom tooth, about the twenty-first year. 

There are thirty- two permanent teeth, sixteen in each jaw. 
From the front backward in each side of the jaw we have 
two incisors, one canine, two bicuspids and three molars. 
The incisors cut the food, the canines tear it and the molars 
grind it. 

Through what medium is the blood relieved of effete 
matter and provided with new material? 

The blood is relieved of effete materials through the sweat, 
urine, feces and exchange of respiratory gases in the lungs. 

It is provided with new material through the respiratory 
exchange of gases, from the gastrointestinal tract through 
the portal vein and lacteals, and from the ductless glands, as 
the thyroid, spleen, adrenals ; also from marrow of bones. 

How is normal body temperature regulated and sus- 
tained? 

It is regulated by the thermotaxic centers of the nervous 
system, and sustained by metabolism of the tissues, especially 
the muscular and glandular. 

State where in the human economy the following sub- 
stances are found, — fibrin, mucin, chondrin, leucin, hip- 
puric acid. 

Fibrin is found in clotted blood, mucin in the mucous 
secretion, chondrin in cartilage, leucin in the intestines, hip- 
puric acid in urine. 

What stimuli produce muscular contraction? What is 
the nervous mechanism of muscular contraction? Il- 
lustrate. 

Stimuli producing muscular contraction are the normal 
nervous stimulus, electrical, mechanical, chemical, and 
thermal. 



PHYSIOLOGY. 585 

In the nervous mechanism of muscular contraction, the 
motor impulse starts from the motor nerve cell, passing down 
the motor neuraxon to the motor end plates, and here the 
muscle cells are stimulated to contract. One stimulus would 
simply cause a muscular twitch, but normally in a muscular 
act a series of impulses are sent from the nerve centers to 
keep the muscles in a voluntary tetanus. 

In raising the foot the motor impulse starts in the cere- 
bral grey cells of the Rolandic area, passes down to the cells in 
the anterior horn of the opposite side of the lumbar cord, then 
out through the sciatic nerve to the motor end plates of the 
muscles required to lift the foot, which in turn stimulate 
the muscular fibers. 

Define stammering and state what causes it. 

Stammering is a defect of speech due to the spasmodic 
action of the diaphragm interrupting the now of air past the 
vocal cords. The larynx and lips are under control. 

Define and describe respiratory rhythm, respiratory 
sounds. 

Respiratory rhythm is the relation between the time of in- 
spiration and expiration. Inspiration is to expiration as five 
is to six, the expiration being followed by a short pause. 

The respiratory sounds are the sounds heard in ausculting 
the lungs. There are two sounds. One is the vesicular 
breathing, which is a low-pitched, soft, distant breezy sound, 
the inspiration being to expiration as three or four is to one, 
in fact expiration may be a mere puff. 

The second is the bronchial breathing, heard over the 
trachea and primary bronchi. It is high-pitched, blowing or 
tubular in quality, the expiration being louder, a little longer 
and higher pitched than inspiration. 

What are the functions of the skin and its appendages? 

The skin and its appendages protect from drying and 
other injury the underlying tissues, especially the end or- 
gans of the sensory nerves in the skin. The hair prevents 



586 PHYSIOLOGY. 

friction and also protects sensitive parts from extremes of 
temperature. On account of the large extent of its surface 
and also on account of the sweat glands it contains, the skin 
is a great heat dissipating organ. 

Describe the physical appearance and characteristics of 
the blood. Compare arterial with venous blood. 

Blood is a red alkaline liquid, with a nauseating salty 
taste and peculiar odor. It has a specific gravity of about 
1055, and coagulates when exposed to air or on coming in 
contact with foreign bodies. 

Arterial blood as compared with venous blood is brighter 
in color, contains more oxygen and less carbon dioxide and 
clots more rapidly. 

Define myopia, hypermetropia, astigmatism. State the 
cause of each of these conditions. 

Myopia or nearsightedness is a defect in vision in which 
parallel rays of light are focussed in front of the retina. It 
is due usually to an increased length in the anteroposterior 
diameter of the eye. 

Hypermetropia or farsightedness is a defect in vision in 
which parallel rays of light are brought to a focus beyond 
the retina. It is generally due to a shortening of the an- 
teroposterior diameter of the eye. 

Astigmatism is an error of refraction in which rays of light 
in the various planes are not equally refracted, some of the 
rays possibly being focussed on the retina, others behind or 
in front of it. It is generally due to irregularities in the 
curvature of the cornea, but sometimes of the lens. 

What is the physiologic function of the liver? 

The liver secretes bile, forms glycogen, urea, uric acid, con- 
jugate sulphates, destroys some of the red corpuscles and in 
foetal life forms some red corpuscles. It also destroys many 
poisons taken into the body. 



PHYSIOLOGY. 587 

State the manner in which blood circulates through the 
heart and the lungs, beginning at the right auricle. 

The blood passes from the right auricle through the tri- 
cuspid valve into the right ventricle; thence through the 
pulmonary valve into the pulmonary artery, which divides 
and subdivides, finally ending in the capillaries around the 
air cells. The blood is recollected and emptied by the pul- 
monary veins into the left auricle; then it passes on through 
the mitral valve into the left ventricle; it is then forced out 
through the aortic valve into the aorta. 

Compare arteries, veins and capillaries in respect to 
rapidity of the blood stream. 

The blood flows in the arteries at about the rate of twelve 
inches a second, in the veins seven inches a second, and in the 
capillaries two inches a minute. 

What tests should be applied to ascertain the integrity 
of (a) the superficial reflexes, (b) the deep reflexes? 

To ascertain the integrity of superficial reflexes we have 
the plantar reflex or movement of the toes on stroking the 
sole of the foot; the cremasteric, the retraction of testicle on 
gently stroking the inside of the thigh; the epigastric, con- 
traction of abdominal muscles on stroking the side of the 
abdomen; the ciliospinal, dilatation of the pupil on pinching 
the skin ; and many others. 

Of the deep reflexes, the knee jerk is the one usually sought 
after. On tapping the tendon below the patella the quadri- 
ceps is thrown into action. We also have a bicipital reflex 
or contraction of biceps on tapping the tendon at the elbow. 

What would be the effect of a transverse section of 
(a) the anterior root of a spinal nerve, (b) the posterior 
root of a spinal nerve? 

Transverse section of the anterior root would cause motor 
paralysis of the muscles it supplied, and finally atrophy of 
the muscles. 



588 PHYSIOLOGY. 

Transverse section of the posterior root would cause loss 
of sensation of the part it supplied. 

Describe the physical properties of (a) lymph, (b) chyle. 

Lymph is a yellowish, salty, albuminous liquid, with a 
specific gravity of 1015. On exposure to air it clots and 
coagulates on heating. 

Chyle is simply lymph plus the minute globules of absorbed 
fat, and is milky white in color. 

How does impairment of the function of one of the fol- 
lowing affect the other two: (a) the skin, (b) the lungs, 
(c) the kidneys. 

Impairment of the function of the kidneys causes increased 
activity of the skin; and at times dyspnoea, asthmatic at- 
tacks, urinous breath, Cheyne-Stokes breathing, and con- 
gestion of lungs. 

What is the function of the trochlear nerve? 

The trochlear nerve is the motor nerve of the superior 
obliquB. 

Describe an epithelial secreting surface. 

The mucous membrane of the stomach consists of a layer 
of columnar epithelium resting on a layer of loose connective 
tissue, containing some involuntary muscular fibers and many 
small blood-vessels and lymphatics. Dipping down from 
the epithelial layer are numerous small glands. These glands 
are lined with cubical epithelium and secrete the gastric juice. 

In the glands of the cardiac end and of the fundus, beside 
the cubical cells, we also find along the sides a number of 
spheroidal cells. These are the cells that form the hydro- 
chloric acid. 

Discuss the action of the gastric juice on carbohydrates 
and fats. 

The gastric juice has no effect on fats, except to melt some 
of them because of its temperature. 

As to the carbohydrates starch is unaffected, but the hy- 



PHYSIOLOGY. 589 

drochloric acid probably inverts some of the cane sugar 
present in the food. 

Give the composition, reaction and uses of blood. 

The blood is composed of 60 parts plasma and 40 parts 
corpuscles. 

In a thousand parts of plasma ninety-eight are solid. The 
bulk of the solid matter is composed of the proteids, serum 
albumin, serum globulin and fibrinogen. Beside these we 
have various salts, especially compounds of sodium, calcium, 
potassium and magnesium in combination with chlorine, phos- 
phorus and carbon dioxide. There are also fats, urea, uric 
acid, dextrose and cholesterin. 

The blood is alkaline in reaction. 

The red corpuscles are composed of water 69%, hemoglobin 
29%, and small quantities of other proteids, salts and ex- 
tractives. 

The white corpuscles contain globulin, albumin, nuclein, 
various salts and the mother body of fibrin ferment. 

The blood carries the absorbed food and oxygen to the 
tissues and carries away waste to the organs excreting them. 
It also equalizes the temperature of the various parts of the 
body. 

Describe the process of absorption by (a) the blood- 
vessels, (b) the lymphatics. 

The digested food is carried through the columnar epithe- 
lium of the intestinal villi by the force of osmosis and the 
vital activity of the cells, the peptones being changed during 
their passage into albumins and globulins. The carbohy- 
drates, soluble salts and proteids pass into the capillaries 
and then on into the portal vein, which carries them to the. 
liver. From here they pass out through the hepatic vein into 
the general circulation. The fats are taken up by the lacteals 
and carried to the receptaculum chyli and then up through 
the thoracic duct into the left subclavian vein. 



590 PHYSIOLOGY. 

Describe the red blood corpuscles. Give the best known 
and most important function of the red blood corpuscles. 

The red corpuscles are non nucleated, elastic, biconcave 
discs about one thirty-two hundredth of an inch in diameter. 
They are yellowish green when seen under the microscope. 
In large masses they are red. They carry the oxygen to the 
tissues. They consist of a stroma in which is imbedded the 
hemoglobin. 

Describe the structure of the arteries. How do arteries 
exercise their function? 

The arteries have three coats, — tunica intima, media and 
adventitia. The intima or internal coat consists of a lining 
of a single layer of endothelial cells and a layer of yellow 
elastic tissue. The media or middle coat is composed es- 
pecially of involuntary muscular fibers arranged transversely 
to the long axis, but it also contains many elastic fibers. The 
adventitia or outer coat is made up of a supporting layer of 
areolar tissue in which are many yellow elastic fibers. 

In the media we find many little ganglionic masses, the 
local vasomotor system. In these the vasomotor nerves end. 

The arteries exercise their function on account of being 
closed tubes, by reason of their contained elastic tissue, and 
by the action of the vasomotor influence of the nervous sys- 
tem on the muscular fibers. 

Describe the fetal circulation. 

The blood coming from the placenta through the umbilical 
vein passes into the inferior vena cava, some of it passing 
first into the liver by the ductus venosus and then into the 
inferior vena cava. It is then carried into the right auricle, 
where it meets the blood returning by the superior vena cava 
from the head and upper extremities. 

The currents do not mix to any extent, but by means of the 
Eustachian valve the blood from the inferior vena cava flows 
through the foramen ovale into the left auricle, where it 
meets the small amount of blood coming from the lungs and 



PHYSIOLOGY. 591 

is passed on into the left ventricle and out through the aorta 
to supply especially the head and arms. 

The blood from the superior vena cava passes through the 
right auricle into the right ventricle and then out through 
the pulmonary artery. Some of this blood passes to the 
lungs, but most of it passes through the ductus arteriosus into 
the descending aorta, where it mixes with the blood from the 
left ventricle and supplies the lower extremities, a portion 
passing through the umbilical arteries to the placenta. 

Mention the erectile tissues of the body and explain 
their function. 

The erectile tissues of the body are the penis, clitoris, 
nipples, and according to some, the mucous membrane of 
nose. They are concerned in the genital sense, increasing the 
sexual excitement and helping complete orgasm. 

What digestive changes take place in (a) the small in- 
testines, (b) the large intestines? 

In the small intestines proteids are changed into peptones 
and even lower bodies, as arginin and leucin; fats are split 
up, saponified and emulsified; undigested starch is changed 
into maltose, which in turn is changed into dextrose, and cane 
sugar is inverted. 

In the lower part of the small intestine and in the large 
intestine microbic digestion is carried on with the forma- 
tion of putrefaction products, carbon dioxide, methane, 
hydrogen sulphide, hydrogen, indol, skatol, phenol, butyric 
acid, valerianic acid, leucin, tyrosin, trimethylamine, and 
many other products. 

Describe the structure of (a) striated muscle, (b) non- 
striated muscle. Which of these is called voluntary, and 
why? 

Striated muscle is composed of fibers transversely striated. 
Each fiber is about one inch long and one five-hundredth of 
an inch in diameter. 

The fibers consist of an outside sheath or sarcolemma, which 



592 PHYSIOLOGY. 

is filled with a liquid, the sarcoplasm. Imbedded in this we 
find the muscle columns or sarcostyles. These are divided by 
a Kraus membrane into sarcomeres, each of which is com- 
posed of a central dark portion, the sarcous element, and on 
either side a lighter portion. 

Non-striated muscle is formed of small spindle-shaped 
nucleated cells, not transversely striated. It has some faint 
longitudinal striations. 

Striated muscle is voluntary, that is, under the control of 
the will. 

Define reflex nervous action. Give examples. 

A reflex action is an afferent impulse followed by an ef- 
ferent impulse independent of the higher cerebral centers. 
A blow in the solar plexus causes an inhibition of the heart. 
The testicle retracts when the inner surface of thigh is stroked. 

Describe the rods and cones of the retina. 

The layer of rods and cones of the retina is the ninth and 
is separated from the choroid by the tenth or pigment layer. 
The rods are more abundant than the cones, about five to one, 
but are absent in the fovea centralis, the cones only being 
present. In the outer end of the rods the visual purple is 
found. The cones are shorter than the rods and contain 
no visual purple. The optic nerve ends in these rods and 
cones, which are the active receptive organ of sight. 

Describe the sphygmograph and state its use. 

The sphygmograjph or pulse recorder essentially consists of 
a spring fastened at one end, with a button on the other 
end to press on the artery, and a system of fine levers so ad- 
justed as to write the movements of the spring on strips of 
glazed, blackened paper. 

How is accommodation in the eye accomplished? What 
is color blindness? 

Accommodation is accomplished by the contraction of the 
ciliary muscle relaxing the suspensory ligament and thus al- 



PHYSIOLOGY. 593 

lowing the crystalline lens to become more convex, which it 
then does on account of its elastic capsule. 

Color blindness is the inability to distinguish certain colors, 
usually red and green. 

How do veins, arteries and capillaries differ as to (a) 
structure, (b) function. 

The arteries have three coats, which contain more muscular 
and elastic tissue than the veins. The arteries have no 
valves, while many of the veins have. The capillaries are 
formed of a single layer of lance-shaped endothelial cells. 

The arteries carry the blood from the heart to the capil- 
laries. The veins carry it back to the heart. Through the 
capillary wall osmosis and diapedesis occur; thus the tissues 
are nourished and the waste matter is carried off. 

What is the function of each class of foods in the 
nutritive process? 

The proteids repair the tissue; the carbohydrates are the 
body fuel, being easily oxidized; the fats are not so readily 
oxidized but are used up to form heat, the excess being stored 
in the adipose tissue; the salts are necessary to keep some 
of the proteids in solution, to regulate osmosis, to neutralize 
the acid produced by katabolism, to form bone, and are a 
necessary ingredient in most of the secretions. 

State the origin and the uses of (a) lymph, (b) the bile. 

Lymph is the diluted blood plasma that has osmosed through 
the capillary wall, to which is added lymphocytes formed in 
the lymphatic glands. It bathes and nourishes the tissues, 
carries away waste and adds lymphocytes to the blood. The 
products of some of the ductless glands are emptied into it. 

The bile is formed in the liver. Bile neutralizes the acid 
chyme precipitating the pepsin, aids in the emulsification and 
absorption of fats, is an antiseptic, increases peristalsis, and 
contains some waste products. 

In what manner is the heart=beat influenced by the 

38 



594 PHYSIOLOGY. 

pneumogastric nerve? What is the average number of 
heartbeats per minute in (a) a child aged one year, (b) 
an adult aged seventy years? 

Stimulation of the pneumogastric nerve causes a slowing 
of the heart. 

The average number of heart-beats at one year of age is 
about 115, at seventy years of age, about 70. 

Define emulsification, saponification. Illustrate. 

Emulsification is the breaking up of a fat into very small 
particles and holding them in suspension in a liquid in which 
they will not dissolve, as shaking together bile, water, and 
olive oil. 

Saponification is the replacing of the glycerin of a fat by 
an alkali, as the mixing of olein and sodium hydrate to form 
sodium oelate and glycerin. 

What causes an increased flow of bile into the 
duodenum? What pathologic effects ma3' ensue because 
of occlusion of the ductus communis choledochus? 

The act of digestion causes an increased flow of bile into 
the duodenum, as will also certain drugs, as calomel and 
podophyllin, and irritation of the intestinal mucous mem- 
brane. 

Occlusion of the ductus communis choledochus is followed 
by jaundice with its tendency to malaise, headaches, anaemia 
and slowing of the heart's action. It also interferes with the 
digestion and absorption of fats, allows of an excess of putre- 
factive substances being formed in the intestines, and also 
causes constipation. 

State the function of the third cranial nerve. What is 
the effect of division of the third cranial nerve? 

The third nerve is the motor nerve for the internal rectus, 
superior rectus, inferior rectus, inferior oblique, levator palpe- 
brarum, ciliary muscle and the constrictor of the pupil. Sec- 
tion of this nerve causes loss of accommodation, ptosis, ex- 
ternal or divergent squint and diplopia. 



PHYSIOLOGY. 595 

What are the movements of the eyeball? Mention the 
muscles concerned in each of the movements. 

Protrusion — caused by the muscular fibers in the capsule 
of Tenon. 

Retraction — caused by the tight closing of the lids or para- 
lysis of the muscular fibers in the capsule of Tenon. 

Upward movement — caused by contraction of superior rec- 
tus and inferior oblique. 

Downward movement — caused by contraction of inferior 
rectus and superior oblique. 

Inward movement — caused by contraction of internal 
rectus. 

Outward movement — caused by contraction of external 
rectus. 

Rotary movement — caused by contraction of either of the 
two oblique muscles. 

What are the accepted theories as to the origin of (a) 
the red blood corpuscles, (b) the white corpuscles? 

The red corpuscles are formed in the red marrow of bones 
and in the spleen. 

The white corpuscles are formed in the lymphatic system, 
the spleen and the marrow of bones. 

How is the diaphragm affected in expiration? State 
cause. 

The central tendon of the diaphragm is drawn upward into 
the thorax during expiration by elastic recoil of the lungs, 
tending to produce a vacuum in the pleural cavity. 

Define secretion, excretion, protoplasm, assimilation. 

A secretion is that product of glandular activity needed 
in the various processes of the living organism. 

An excretion is that product of glandular activity con- 
taining waste of no further use to the organism. 

Protoplasm is the living substance surrounding a specially 
formed element called the nucleus. 



596 PHYSIOLOGY. 

Assimilation is the conversion into protoplasm of nutrient 
material or food ingested. 

What are the causes of the apex beat of the heart? 

The apex being free it is brought forward to strike against 
the chest wall by the contraction of the ventricle. The shock 
of the contracting muscle also contributes to it. 

What special use does each of the following serve in the 
body after ingestion,— proteids, fats, carbohydrates, al- 
cohol, tea and coffee. 

Proteids repair the tissues, fats are used for body fuel and 
as a reserve, carbohydrates are the body fuel, alcohol in 
small doses is a general stimulant and by irritating the 
mucous membrane causes an increased flow of gastric juice. 
Tea and coffee are stimulants, increasing the flow of the 
various secretions and stimulating peristalsis. 

State the functions of the fifth cranial nerve. 

The fifth nerve is the sensory nerve of the face, mouth 
and nasal cavities, and the motor nerve of the muscles of 
mastication. 

What effect, if any, results from the division of (a) a 
vasoconstrictor nerve, (b) a vasodilator nerve? 

Division of a vasoconstrictor nerve causes a vasodilation 
in the part it supplies. 

Division of a vasodilator nerve usually has no effect. If 
it be in action at the time, a vasoconstriction would follow. 

Describe the vermicular movement of the stomach and 
intestines. What purpose does this movement serve? 

The movement of the stomach causes the food there to be 
thoroughly mixed, the peculiar contraction causing a current 
down along the fundus to the pylorus and back again along 
the lesser curvature. 

The movement of the intestine is a true peristaltic one, that 
is, one segment of the intestinal walls contracts after the 



PHYSIOLOGY. 597 

preceding segments; thus a wave of contraction passes down, 
mixing and pressing the food on downward. 

Differentiate white fibrous tissue and yel!ow=elastic 
tissue as to (a) structure, (b) distribution. 

White fibrous tissue consists of white fibers arranged in 
parallel bundles, the connective tissue cells also being ar- 
ranged in this way. Yellow-elastic tissue is a connective 
tissue in which the yellow fibers predominate. These fibers 
are larger than the white and are bound together with areolar 
tissue. The white fibrous tissue is found where strength and 
inelasticity is needed, as in the ligaments and tendons. 

The yellow fibrous tissue is found where elasticity is 
needed, as in the coats of the bloodvessels, in the lungs, and 
vocal cords. 

Explain the action of the anospinal center in defecation. 

The anospinal center is the reflex center for defecation. 
Irritation of the mucous membrane of the rectum sends an 
impression to the anospinal center, which then causes a re- 
laxation of the sphincter muscles and an increase in peris- 
talsis. This center is under the control of the will to a great 
extent. 

How is the venous blood current maintained? What 
arteries carry venous blood? 

The venous flow is maintained by the vis a tergo, or force 
of the heart carried through the capillaries, by the play of 
the valves in the veins during muscular movements, and by 
thoracic and intracardiac action. The pulmonary arteries 
carry venous blood. 

What causes the difference in pitch between male and 
female voices? What causes the voice of the youth at the 
period of puberty to " crack?" 

The male vocal cords are longer, hence the lower pitched 
voice. 

The cause of the cracking of voice at puberty is the change 



598 PHYSIOLOGY. 

from the childish treble to the lower adult voice, causing 
now and then a treble tone to be put in. 

What is the function of connective tissue? 

The connective tissue acts as a binding, supporting, con- 
necting and protecting tissue for the more delicate tissues 
and organs. 

What is (a) an efferent nerve, (b) an afferent nerve? 
Illustrate. 

An efferent nerve is one carrying impulses from the cen- 
tral nervous system to the various parts of the body. The 
facial nerve carries motor impulses from the central nervous 
system to the muscles of expression. 

An afferent nerve is one carrying impulses to the central 
nervous system from the various parts of the body. The 
optic nerve carries impressions received on the retina to the 
brain. 

Describe the glands and villi of the intestines. 

In the intestines we find two sets of glands, Brunner's 
and Lieberkuhn's. 

The glands of Brunner are branched convoluted tubular 
glands found dipping down in the mucous membrane of the 
duodenum only. 

The crypts of Lieberkuhn are little tubular depressions in 
the mucous membrane of both the small and large intestines. 
They are larger in the large intestine. They consist of a 
basement membrane lined with columnar and goblet-shaped 
epithelial cells. 

The villi are small nipple-like projections from the mucous 
membrane of the small intestines about one-thirtieth of an 
inch long. 

A villus consists of a mass of adenoid tissue covered with 
a layer of columnar epithelium resting on a basement mem- 
brane. In the center of this adenoid tissue we find a little 
lymphatic called a lacteal. We also find in the adenoid tissue 
many capillaries which coalesce to form the venules of the 
mesenteric veins. 



PHYSIOLOGY. 599 

Describe the movements of the blood corpuscles in the 
capillaries and explain the phenomena of diapedesis. 

The capillaries are on an average just large enough to al- 
low the red corpuscles to pass through. In passing through 
some of the capillaries they are altered somewhat in shape, 
but on account of their elastic stroma immediately resume 
their shape when the pressure is removed. As they have to 
flow along in single file at juncture of two capillaries to form 
one, they take alternate turns in passing into it. 

The white corpuscles tend to adhere to the wall and do 
not move as rapidly as the red ones. 

In diapedesis the white corpuscle pushes one of its pseu- 
dopodia through the cement substance of the cells of the 
capillary wall, and then pulls the rest of the body through 
after it. 

Mention three varieties of cells according to situation 
in the body. 

Epithelial cells are found in the skin. 

White blood corpuscles are found in the blood. 

Nerve cells are found in the central nervous system. 

What is the mode of production of heat in the body? 

Heat is produced by the chemical action going on in the 
tissues, especially in the muscular and glandular tissues. 

Describe cholestrin, giving its origin and function. 

Cholestrin is a monatomic alcohol found especially in the 
nervous tissue, and thrown off in small quantities from the 
body in bile. It is possibly a waste product of the nervous 
tissue. 

Mention and describe three varieties of cells according 
to shape. 

Involuntary muscular fibers are small spindle-shaped cells, 
containing about their center an oval nucleus. They are 
faintly longitudinally striated. 



600 PHYSIOLOGY. 

Squamous epithelial cells are flat scale-like cells, having 
a small nucleus near their center. 

White blood corpuscles are nucleated granular masses of 
protoplasm, about one twenty- five-hundredth of an inch in 
diameter. At rest they are globular, but during ameboid 
movement are irregular in shape. 

Mention the ductless glands and give the theory as to 
the function of any one of them. 

The ductless glands are the thyroid, thymus, adrenals, 
spleen, pituitary body, coccygeal and carotid. Many other 
organs have also internal secretion. 

The adrenal secretion has a marked influence over vaso- 
motor and general muscular tone. 

How is the sensation of sound conveyed to the brain? 

It is conveyed from the cochlea by the auditory nerve to 
the medulla, then to the superior olive, through lateral fillet 
to the posterior quadrigeminal bodies to the cerebral cortex. 

What matters are excreted by the skin? How may the 
function of the skin be affected as to the amount of ex= 
cretion? 

The sweat contains one per cent, of solid matter, in which 
we find sodium chloride and other inorganic salts, urea, fatty 
acids and coloring matter. 

The function of the skin may be affected physiologically 
by increased urination and diarrhoea, by reflex irritation >£ 
sweat centers, by the emotions, by increase of body tempera- 
ture calling for more heat dissipation, and by the accumula- 
tion of carbon dioxide in the blood. Ingestion of many drugs 
also affects the excretion. 

Mention some of the exercises that injuriously affect 
the heart. State the reasons for your conclusion. 

Among exercises that injuriously affect the heart are 
wrestling, long distance racing, bicycle racing and rowing 
matches, the bad effect being due to the sudden strain which 
causes dilatation and hypertrophy of the heart. 



PHYSIOLOGY. 601 

State the function of the retina. 

The retina is the receptive nervous organ of sight. 

What are the physiologic characteristics of protoplasm? 

Protoplasm has the power of nutrition, growth, reproduc- 
tion, movement and response to stimuli. 

What is the usual difference in shape between the red 
corpuscles of the blood in the mammalia and those in 
the ovipara? 

With the exception of the camels, mammalian red cor- 
puscles are non-nucleated, biconcave, circular discs. In the 
ovipara they are nucleated, oval and biconvex. 

State the changes in the diameter of the chest in in= 
spiration and expiration. 

In inspiration the vertical diameter is increased by the 
descent of the diaphragm; the anteroposterior and trans- 
verse diameters are increased by the raising and rotation of 
the ribs anteriorly and laterally. 

The reverse occurs- during expiration. 

The circumference of the chest is increased in forced in- 
spiration from 2 to 5 or 6 inches over forced expiration. 

Explain the anatomic and physiologic difference be- 
tween mucous, serous, and synovial membrane. 

Mucous membranes are secreting membranes lining cavities 
opening into the air and composed of one or more layers of 
epithelial cells. 

Serous membranes are those lining closed sacks belonging 
to the lymphatic system and composed of a single layer of 
flat endothelial cells on a basement membrane. 

Synovial membranes are those lining closed sacks or bursae 
in joints or over tendons. They secrete synovia, which al- 
lows free motion by preventing friction. 

Describe the physical properties of healthy urine. 

Healthy urine is a straw yellow, acid, clear liquid, with 
a specific gravity of 1015 to 1025, and with a peculiar odor. 



602 PHYSIOLOGY. 

On standing, a slight sediment collects in the lower part of 
the liquid. 

Describe the changes in form and volume, and in physi- 
cal and chemical properties, occurring in the contraction 
of a muscle. 

The muscle becomes shorter, but the volume remains the 
same. It becomes acid in reaction, more oxygen is used up 
and more carbon dioxide given off, sarcolactic acid is gen- 
erated, glycogen is used up, and the muscle substances soluble 
in water are diminished in amount, while those soluble in 
alcohol are increased. 

Locate in the brain, the seat of the special sense of 
sight, hearing and smell. 

Sight has its seat in the gyrus angularis, cuneus, and in 
the occipital lobes; hearing in the superior temporal; smell 
in the uncus. 

Explain the phenomena and causation of auditory ver= 
tigo or Meniere's disease. 

It is due to some disturbance or abnormal irritation of the 
endings of the vestibular branch of the auditory nerve. This 
branch normally sends impressions to the nucleus fastigii in 
the cerebellum which help to control the balancing and co- 
ordination of the muscles of the body. 

How do the striped and unstriped muscular fibers differ 
in response to stimuli? 

The unstriped muscular fibers are much slower in response. 

What is the order of occurrence of rigor mortis in the 
different parts of the body? 

Rigor mortis usually begins in the muscles of the eye, 
passing to the jaw and neck muscles, and in turn to the 
chest, arms, abdomen and lower extremities. 



PHYSIOLOGY. 603 

What relation does the nervous system bear to the 
excretion of perspiration? 

The nervous system through the sweat centers regulates the 
excretion of perspiration. 

What portion of the cerebrum comprises the motor area? 

The motor area is found along the fissure of Rolando in 
the ascending parietal, ascending frontal and paracentral con- 
volutions and contiguous parts of the superior frontal. 

Give the presumptions of survivorship and reasons 
therefor in the following from Casper: A is killed by a 
thrust of a saber on the head; B by that of a bayonet in 
the heart; and C by a shot which has torn open the jugular 
vein. 

If A's injury involved especially the base of the brain the 
shock of the injury would probably cause instant death. 

B would probably be the second to die, probably living at 
least a half hour until the giving out of the heart from 
pressure of the blood in the pericardium. 

C would be the last to die, as lacerated wounds of even 
large vessels often stop spontaneously, and his bleeding might 
be checked by pressure until surgical help arrived. 

Define the function of the mucous membrane of the 
respiratory tract. 

The mucous membrane of the respiratory tract secretes a 
protecting mucus, and because of its ciliated epithelial cells 
keeps the lungs clear of accumulation of mucus and small 
dirt particles entering in the inspired air. The vital activity 
of the squamous cells lining the air vesicles aids in the ex- 
change of the respiratory gases. 

What is the composition of human milk? 

Milk contains 112 parts of solid matter to the thousand. 
Of these, sixty parts are the carbohydrate, lactose; thirty 
are fats, olein, palmitin, stearin and butyrin; twenty are 
proteids, caseinogen, lactalbumin and lactglobulin ; and two 



604 PHYSIOLOGY. 

parts are salts, especially sodium chloride and calcium phos- 
phate. 

What are the uses of perspiration? 

Through the perspiration we get rid of certain waste pro- 
ducts supplementing somewhat the action of the kidneys. 
Through it we also throw off large quantities of heat. It also 
keeps the skin moist. 

What conditions increase the amount of solids in the 
urine? 

Increased ingestion of salts will increase the amount of 
salts excreted. 

Diarrhoea, free perspiration and limiting the ingestion of 
fluids, will cause a relative increase of solids. Excessive 
muscular exercise will also cause a small increase in the 
amount of solids. 

What are the functions of the pneumogastric nerves? 

Among its many functions the pneumogastric is motor and 
sensory to the larynx, motor to the pharynx and oesophagus, 
motor, sensory and secretory to the stomach, inhibitory of the 
heart, motor and sensory to the lungs, and sends some fila- 
ments through the sympathetic system to the pancreas, liver 
and intestines. 

How are the sensations of color produced? 

According to the Young-Helmholtz theory there are three 
sets of retinal fibers, each responding to the stimulation of 
one of the primary colors, green, red and violet. Stimula- 
tion of these in different degrees causes the various shades. 

According to the Hering theory there is one set of fibers, 
while there are three chemical substances found in visual 
purple. The anabolism of these causes white, red and yellow ; 
katabolism, black, green and blue. Various combinations 
cause various shades. 

Describe the portal circulation; the renal circulation. 

The blood collected from the capillaries of the spleen, 



PHYSIOLOGY. 605 

stomach and intestines by the splenic, gastric, inferior and 
superior mesenteric vein is carried by the portal vein to 
the liver. Here this vein breaks up into smaller vessels 
running between the lobules, called the interlobular vessels. 
These break into a set of capillaries, called the lobular capil- 
laries, which coalesce to form the intralobular veins. These 
empty into the sublobular veins, which in turn form the 
hepatic vein which carries the blood into the inferior vena 
cava. The hepatic artery supplies especially the capsule of 
the liver. 

In the kidneys we find three sets of capillaries. One 
set is that of the vasa recta, short vessels given off from the 
arterial trunks and supplying the medullary portion. Then 
we have the arteries of the cortex forming the set of capil- 
laries of the glomeruli. The vessels passing out from the 
glomeruli are called the efferent vessels, and again break 
up into a set of capillaries around the convoluted portion of 
the tubules. The blood is then collected by the renal venules 
and passes out through the renal vein. 

What circumstances and conditions favor gastric di= 
gestion? 

Among the many circumstances favoring gastric digestion 
are thorough mastication, slow eating, pleasant taste to the 
food, swallowing in small mouthfuls, normal amount of con- 
diments, muscular and mental quietude, and a general healthy 
condition of the various parts of the body. 

Describe the physiology of vomiting. 

Vomiting is the spasmodic rejection of the contents of the 
stomach. It may occur from an abnormal condition of the 
vomiting center in the medulla, or refiexly from the irrita- 
tion of many nerves, as the glossopharyngeal in the posterior 
surface of the larynx, or the pneumogastric in the stomach, 
or from the sight of disgusting objects, disgusting tastes or 
smells, or from irritation of other mucous membranes, as the 
uterus. 

During the act of vomiting the diaphragm is fixed, the 



606 PHYSIOLOGY. 

cardiac orifice of the stomach is opened by the longitudinal 
fibers and the abdominal muscles contract, causing the con- 
tents of stomach to be forced into the mouth. 

What would be the effect on digestion if the pancreatic 
duct were obstructed? 

As the pancreatic secretion acts on all classes of food, there 
would be a marked decrease in the whole digestive function, 
especially on the fats and proteids. 

Discuss bacteria in the intestines. 

The bacteria found in the intestines may be divided into 
three groups, — fermentative, chromogenic and pathogenic. 

The first class is very useful, forming peptones, dextrose 
and fatty acids, and breaking up some poisonous principles, 
as choline, into simpler bodies. Unless putrefaction becomes 
excessive, it is perfectly normal. 

Among other substances formed during microbic diges- 
tion are indol, skatol, phenol, carbon dioxide, leucin, tyrosin, 
hydrogen sulphide and ammonia. 

Give the relative activity of absorption in the alimen- 
tary canal, the skin and the lungs. 

The relative activity of absorption is first through the 
lungs, then through the alimentary canal, and third through 
the skin. 

Give the process of replacement of temporary by per- 
manent teeth. 

As the jaws grow and can accommodate the larger per- 
manent teeth, the little immature permanent teeth budded 
off from the temporary set begin to grow upward. As they 
grow, the fangs of the temporary teeth are gradually ab- 
sorbed, the crown falls off, and then the permanent erupt. 

What conditions retard, suspend or prevent the coagu- 
lation of blood? 

The conditions retarding, suspending or preventing coagu- 
lation are — addition of oxalates, proteoses, peptones or leech 



PHYSIOLOGY. 607 

extract ; low temperature ; contact with living vascular walls ; 
the covering of the surface with oil; addition of large quan- 
tities of neutral salts; excess of carbon dioxide; death by 
lightning; and the diseased condition, hemophilia. 

What is the function of the superior laryngeal nerves? 

The superior laryngeal nerves are the motor for the crico- 
thyroid muscles and the sensory for the larynx. 

Discuss the effect of the cooking of food as a means of 
rendering it more digestible. 

It is especially on the starchy foods that cooking has a 
good effect by breaking up the cellulose covering of the starch 
granules and forming some of the starch into dextrine. 

The fats in the cells are also liberated. 

Upon the proteids cooking has rather a detrimental effect, 
especially if the temperature is raised very high. For in- 
stance, the uncooked egg albumin is more readily digested 
than the coagulated cooked albumin. 

What agencies induce the flow of lymph to the point 
of discharge in the veins? 

The now of lymph is induced by the vis a tergo or pressure 
in the tissues, by muscular action and the play of the numer- 
ous lymphatic valves, by muscular tissue in the lymphatic 
vessels, and by thoracic suction. 

Name some of the involuntary muscles and the function 
with which each is concerned. 

The uterus is the organ for the carrying of the developing 
embryo and foetus. The muscle is used for the expulsion of 
the foetus at the end of intrauterine life. 

The muscular wall of the intestine is used for mixing and 
passing on downward the food received from the stomach. 

The tunica media of the arteries contains many muscular 
fibers that control the supply of blood to the various parts 
of the body. 



608 PHYSIOLOGY. 

What do you understand by blood pressure? 

Blood pressure is the pressure to which the blood is sub- 
jected in the circulatory system. In man it is about 110 
millimeters of mercury. 

What effect does an excessive starchy diet produce? 

It produces excessive flatulency and may lead to an ali- 
mentary glycosuria. 

Give the mechanism of the organs of hearing. 

The sound waves are converged by the auricle, pass through 
the external auditory meatus, striking then against the mem- 
brana tympani, which sets into movement the ossicles, malleus, 
incus and stapes. The base of the stapes fits into the oval 
window. Thus the sound waves cause a movement of the 
ossicles, which in turn, through the base of the stapes, cause 
vibrations to be set up in the perilymph of the vestibule ; then 
they are conveyed through the scala vestibuli and through 
the helicotrema to the perilymph of the scala tympani, and 
out through the round window to be dispersed. 

The vibration of the perilymph in the cochlea sets up 
vibration in the scala media containing the organs of Corti, 
which are the special receptive apparatus of hearing. 

The impressions received here are carried by the cochlear 
branch of the auditory nerve to the cerebrum. 

What is meant by digestion? 

The nutrient material or food ingested has to be so changed 
that it can be absorbed. This changing of the food is called 
digestion. 

What influence has the nervous system on the process 
of secretion? 

The nervous system controls the process of secretion by 
the various secretory centers and nerves, and by controlling 
the amount of blood to the various organs of the body. 



PHYSIOLOGY. 609 

Name the refracting media of the eye and the effect that 
each has on the rays of light. 

The refracting media of the eye are the cornea, aqueous 
humor, crystalline lens, and the vitreous humor. 

They all converge the rays of light, the cornea being the 
most potent, the crystalline lens coming next, then the vitreous 
and finally the aqueous humor. 

What is the location of the center for articulate speech? 

The center for articulate speech is in Broca's convolution, 
the left lower frontal in right-handed people. 

How is the sensation of pain produced? 

Stimulation of the special endings of the pain nerves in 
the skin, or stimulation of the trunk of the nerve, causes an 
impression to be sent to the special area of the brain pre- 
siding over pain sensations. When this center is so stimu- 
lated we feel pain. 

What kinds of food would you recommend in cases of 
obesity? 

The whole diet including water should be restricted and 
the relative amount of proteids greatly increased in cases 
of obesity. 

Give the reactions of the following fluids and state the 
cause of the reaction in each case, — urine, blood, gastric 
juice and pancreatic juice. 

Urine is acid from the acid phosphate of sodium which it 
contains. 

Blood is alkaline from its contained alkaline phosphates 
and carbonates. 

Gastric juice is acid from the hydrochloric acid in it. 

Pancreatic juice is alkaline from the sodium carbonate it 
contains. 

Describe the mechanism of the diaphragm in respiration. 

During inspiration the diaphragm contracts and the central 
tendon is thus drawn downward. During expiration the dia- 
39 



610 PHYSIOLOGY. 

phragm relaxes. As the elastic tissue of the lungs forces 
the air out of the lungs, the central tendon is drawn upward 
to fill the intrapleural vacuum. 

Do variations in the rate and force of respiration affect 
the heart, and if so, in what manner? 

Increase in the rate and force of respiration increases the 
number and force of the heart beats. A deep inspiration 
held for sometime will reduce the rate of a rapid heart. 

Name the organs of the special senses. 

The organs of special sense are the eye, ear, upper por- 
tion of nasal cavity, the taste bulbs on the tongue, and the 
tactile end organs. 

Describe the functions of spinal nerves. 

The spinal nerves carry the afferent and efferent impulses 
of the body and of the back of head to and from the central 
nervous system. 

Among the afferent impulses we have those of pain, tem- 
perature, tactile, pressure and muscular sense. 

Among the efferent, we have the motor, trophic, secretory 
and vasomotor. 

Describe the effect of a transverse section of the spinal 
cord in the mid=dorsal region. 

A transverse dorsal section would cause paralysis of mo- 
tion and of sensation of the parts below the section, paralysis 
of bladder and rectum, and exaggerated reflexes of the legs. 

What is meant by the condition of tetanus in a muscle? 

When a muscle goes into a state of continued contraction, 
it is said to be tetanized. 

Describe the digestion in the stomach of a meal of bread 
and milk. 

The ptyalin of saliva continues for sometime in the stomach 
to change the starch of the bread into maltose. The hydro- 
chloric acid also has some action on the starch. The gluten 



PHYSIOLOGY. 611 

of the bread is changed by pepsin into gluten peptone. The 
caseinogen is changed into casein by the rennin, and then 
the pepsin changes it into casein proteose and peptone. 

The lactalbumin and globulin are also changed into pro- 
teoses and peptones. The soluble salts are dissolved and the 
fats melted. 

What variations of temperature are found in the differ- 
ent parts of the body? Mention the reasons for such 
variations. 

The highest temperature is found in the blood leaving the 
liver, and is due to the amount of heat formed in this large 
gland. 

The tip of the nose is said to be the coldest part of the 
body, due to its exposed position and to the thinness of its 
walls. 

The skin surface is always cooler than the internal or- 
gans, due to the radiation of the heat of the blood from the 
skin, the evaporation of sweat from the skin, and the in- 
creased amount of heat produced in the internal organs. 

Describe the mechanism in the opening and closing of 
the aortic valve. 

The three leaflets of the aortic valve are placed with their 
concavity toward the aorta. During systole the pressure in 
the ventricles forces the blood past the aortic valve into the 
aorta. As the ventricle begins to dilate in diastole the pres- 
sure of the blood in the aorta tends to force the blood back 
into the ventricle. This force fills up the pockets of the 
aortic leaflets and forces their free edges together, thus 
closing the orifice. 

Define life and death. 

"Life is that obscure principle whereby organized beings 
are peculiarly endowed with certain powers and functions 
not associated with inorganic matter." 

" Death is the cessation of life.'' (Dorland). 



612 PHYSIOLOGY. 

Describe the physiology of rectal feeding. 

Small quantities of food, especially if predigested, when 
placed in the rectum are readily absorbed and will sustain 
life as long as the rectum does not become so irritable as not 
to retain the food. The food should preferably be predi- 
gested, but even egg albumin can be absorbed. 

Name the excretory glands of the body and the function 
of each. 

The excretory glands are the kidneys, which excrete urine ; 
the sweat glands, which excrete sweat and dissipate heat by 
sweating; and the liver, which throws off through the bile 
some waste matter. The lungs are ?iso excretory organs, 
throwing off carbon dioxide and nitrogen. 

Describe the origin of a tear as the result of pain. 

The pain causes reflexly a stimulation of the lachrymal 
gland, causing an increased secretion. More secretion is 
poured out than can be carried off by the lachrymal canal, 
the excess pouring over the cheek as tears. 

What is the office of the columnae carneae? 

They give strength to the ventricular wall and prevent 
the auriculoventricular valves from being pressed into the 
auricles. 

Describe the physiologic causes of obesity. 

The physiologic causes of obesity are overfeeding, espec- 
ially with carbohydrates, lack of proper exercise, and cer- 
tain peculiarities of the cells of an individual. 

Name some of the bodily states which lessen the al- 
kalinity of the blood. 

There is a decrease of alkalinity in rheumatism, gout, mi- 
graine, and while living on a diet deficient in the alkaline 
mineral matters, or living on a proteid diet. 

What is the influence of diet on nutrition? 

For nutrition to go on properly the diet must contain the 



PHYSIOLOGY. 613 

various classes of foods in proper proportion. Proteids and 
salts are absolutely necessary. Nothing but proteids can 
replace the used up proteids of tissue. Salts are needed 
especially to neutralize the acids formed during proteid 
katabolism, and to form a part in the secretions, like the 
hydrochloric acid of the gastric juice. 

Describe the physiologic process by which the bite of a 
venemous snake or the hypodermic injection of the virus 
causes death. 

The poison injected under the skin is carried by the 
lymphatics to the right or left subclavian vein. Having thus 
reached the general circulation, it is distributed to the vari- 
ous organs, and so perverts the function of certain ones as 
to cause death. 

Name the bile salts, and state the physiologic function 
of bile. 

The bile salts are sodium glycocholate and sodium tauro- 
cholate. 

Bile aids in the emulsification and absorption of fats, neu- 
tralizes the acid chyme precipitating the pepsin, increases 
peristalsis, is antiseptic, and contains some waste matter 
thrown off by the liver. 

Describe the offices and the characteristics of the gray 
matter of the brain. 

The grey matter of the cerebral cortex is arranged in six 
alternate gray and white layers, the most important of which 
is the deep gray layer of large pyramidal cells. 

The gray matter of the cerebrum is the center of sensa- 
tion, volition and ideation; that is, it receives the sensations, 
sends out all voluntary impulses and is the part of the 
nervous system in which thought goes on. 

Enumerate the physiologic advantage of natural sleep 
and state at what period of life the least sleep is required. 

Natural sleep allows the fatigued nervous system to re- 



614 PHYSIOLOGY. 

gain its tone, causes a relaxation of the vasomotor system, 
thus giving the heart a chance to rest. In fact, sleep causes 
a relaxation of all the bodily functions, thus allowing the 
tissue to recuperate and waste matter to be carried off. 

During mature adult life the body can stand the lack of 
sleep better than at any other time. 

Give the function of the epiglottis. 

The epiglottis is used in vocalization, especially of the 
lower pitched tones. 

What differences of function exist between the white 
and grey matter of the encephalon? 

The grey matter is composed of cells, which are the ter- 
minals that receive sensations, classify the knowledge thus 
received and send out impulses. 

The white matter is made up of fibers that transmit the 
impulses, connecting the cells with each other and with the 
periphery. 

Describe the ileocoecal function. 

The ileocoecal valve is composed of two semilunar folds 
of mucous membrane, containing the circular fibers. When 
the caecum is distended this valve is closed, and thus re- 
gurgitation into the small intestine is prevented. 

State the approximate time of eruption of the temporary 
teeth. 

The lower central incisors erupt about the 5th or 6th 
months, followed rapidly by the other six incisors. About 
the 11th or 12th month the first molars appear. From the 
18th to 20th month the canines erupt, followed from the 
24th to 30th month by the second molars. 

State what are, under normal conditions, the (a) adult 
pulse rate; (b) adult number of respirations per minute; 
(c) body temperature; (d) average respiratory capacity. 

The adult pulse rate is seventy-two per minute; respira- 
tory rate is eighteen per minute; the body temperature is 



PHYSIOLOGY. 615 

98.4° Fahr.; the average respiratory capacity is 230 cubic 
inches. 

Name two circumstances influencing secretion. 

Among circumstances influencing secretion are the supply 
of blood to the gland and the proper action of the normal 
reflex excitants. 

What is the function of (a) sudoriferous glands; (b) the 
sebaceous glands? 

The function of the sudoriferous glands is to excrete 
sweat; that of the sebaceous glands to secrete sebum. 

Name the principal centers of organic function in the 
medulla oblongata. 

The principal centers in the medulla are the respiratory, 
cardioinhibitory, cardioaccelerator, vasomotor, salivation, 
mastication, deglutition, vomiting and diabetic. 

Account for the contraction and dilatation of the pupil. 

The contraction and dilatation of the pupil is a reflex 
phenomenon regulating the amount of light and sharpening 
the image for near objects. 

There are two sets of muscular fibers in the iris, — circu- 
lar or contracting and radiating or dilating. 

Give the composition of normal feces. 

The feces contain 70 to 80% of water. Of the solid mat- 
ter there are indigestible substances as cellulose, mucin and 
keratin; some undigested matter as uncooked starch and 
elastin; products of microbic digestion as indol, skatol, 
phenol, fatty acids and leucin; bacteria; cholesterin; color- 
ing matters, sterecobilin ; and intestinal debris as cells and 
mucus. They are alkaline in reaction, quantity, 6 to 8 ounces 
in 24 hours. 

Describe the disturbances of function produced by the 
excessive imbibition of alcohol. 

Excessive imbibition of alcohol causes congestion of the 



616 PHYSIOLOGY. 

stomach with altered gastric secretion, precipitation of pepsin 
during gastric digestion, congestion of liver and finally de- 
struction of many of the liver cells. On entering the cir- 
culation it acts as an irritant to the whole vascular system 
and to the kidneys. It also causes subnormal temperature. 

How are cells connected? 

Cells are connected by the intercellular substances. 

Give the relative food value and ease of digestion of 
meat, milk, eggs, leguminous fruits. 

According to relative food value the order is — meat, eggs, 
milk and leguminous fruits. 

According to relative ease of digestion the order is, — milk, 
eggs, meat and leguminous fruits. 

What are the effects of removal of the cerebrum in the 
lower animals? 

A decerebrated animal loses all power of voluntary move- 
ment, remaining quiescent until some external stimulus brings 
out a reflex movement. Thus, food may be placed before 
him, but he will not take it; if it is placed in his mouth, he 
will swallow it. If turned on his back, he will right him- 
self. He shows no fear. 

What conditions are necessary for properly exercising 
the sense of smell? 

For the proper exercise of the sense of smell, the sub- 
stance must be volatile, the air in the nasal cavity must be 
in motion, and the olfactory apparatus must be in normal 
condition. 

How would digestion be affected were the ductus com- 
munis choledochos obstructed? 

In obstruction of the ductus communis choledochus the 
feces contain large quantities of undigested fats, the stools 
become hard and fetid, and finally death ensues from ab- 
sorption of putrefactive products from the intestines. 



PHYSIOLOGY. 617 

What constitutes the usual difference between male and 
female voices? 

The male voice is about one octave lower in pitch; that 
is, it is deeper and heavier than the female voice. 

Give the mechanism of the diaphragm in (a) respiration, 
(b) hiccough. 

During rest or relaxation the diaphragm is domed upward. 
During inspiration, the muscle contracts, the central tendon is 
pulled down and thus the vertical diameter of the thorax is 
increased. During expiration, the muscle relaxes and the 
diaphragm resumes its domed position. 

Hiccough is caused by a sudden spasmodic contraction of 
the diaphragm, the inspiration thus caused being arrested 
by a sudden closure of the glottis. 

How does the nervous system influence gastric di- 
gestion? 

Through the vagi the secretion of the stomach is con- 
trolled from the central nervous system. The vasomotor 
nerves of the stomach also influence secretion by controlling 
the amount of blood to the stomach. 

Give the physiology of (a) hunger, (b) thirst. 

Hunger is the constitutional need of the body for food 
with the eccentric symptoms in the epigastrium. The im- 
poverishment and changes in the blood so affect the central 
nervous system as to cause the sensation. 

Thirst is the constitutional need of the body for water 
with the eccentric symptom in the pharynx. The lack of 
water in the blood so affects the nervous system as to cause 
this dryness of the throat. 

Give the foramen of exit, the distribution and the func- 
tion of the pathetic (fourth cranial) nerve. 

The pathetic nerve passes out through the sphenoidal fis- 
sure and is the motor nerve of the superior oblique. 



618 PHYSIOLOGY. 

Give the process of development of the parietal bone. 

The parietal bone is formed between membranes and is not 
preceded by the temporary cartilage. 

The membrane is formed of an external fibrous layer and 
an infernal layer, which becomes the periosteum and consists 
of a layer of osteoblasts. 

Starting from a point called the center of ossification, little 
spicules of bone are deposited in all directions in the inter- 
cellular substances. As they become more numerous, they 
completely enclose the osteoblasts, which remain permanently 
in the bone. This process spreads in all directions and thus 
the bone is formed. 

What changes take place in the composition of blood as 
it passes through the kidneys? 

During the passage of the blood through the kidneys, these 
organs pick out of it large quantities of urea, uric acid, 
sodium chloride, alkaline and earthy phosphates, sodium and 
potassium sulphates, indican, extractives and water. The 
blood also becomes venous, losing oxygen and adding more 
carbon dioxide. 

How are the vocal sounds produced? 

The vocal sounds are produced by vibrations of the vocal 
cords, modified in the case of vowels by peculiarities in the 
shape of the resonating cavities above, mouth, pharynx and 
nasal cavities. In the case of consonants the vibrations are 
modified by a more or less complete interference with the 
outgoing flow of air. 

What would be the effect on the saliva and on digestion 
if Stenson's duct should be divided? 

If Stenson's duct should be divided, the other parotid 
would probably hypertrophy somewhat to make up for the 
loss of secretion. There would be comparatively little effect 
on the saliva or digestion. At first mixed saliva would possi- 
bly be less watery and the digestion of starch somewhat 
retarded. 



PHYSIOLOGY. 619 

Describe the physiologic aspect of atavism. 

Atavism is the peculiarity of the offspring of taking on 
the characteristics of the parent. 

Certain characteristics, inherent in the ovum and spermato- 
zoon and derived from the parents, cause special ' develop- 
ment in the certain lines, thus causing the offspring to take 
on peculiarities of the parents. 

Give the extremes of slowness and rapidity of the heart's 
action which are consistent with physical vigor, and with 
ability to perform manual labor. 

The extremes would probably be from fifty to a hundred 
beats per minute; nevertheless, no definite extremes can 
be given. 

Give the process of regeneration of uterine mucous 
membrane following pregnancy. 

Following pregnancy the mucous membrane of the uterus 
is regenerated from the epithelium of the deep glandular 
layer. Around the mouth of the glands proliferation goes on 
rapidly, the groups of new cells spreading out and finally 
coalescing with each other. About the end of the fifth week 
this new membrane is complete. All cells and shreds of 
decidual tissue not concerned undergo fatty degeneration 
and are thrown off through the lochial discharge. 

In what manner, physiologically, does a largely dis- 
tended stomach produce death? 

A largely distended stomach may cause death by interfer- 
ence with normal digestion, causing excessive fermentation 
and auto-intoxication. Or, pressure on the surrounding or- 
gans causes interference with the circulation and the func- 
tions of the organs. The venous stasis causes hypertrophy 
and dilatation of the heart, which finally gives out, death 
ensuing. 

Give the physiological properties of the facial nerve. 

The facial nerve is the motor nerve for the muscles of 
expression of the face. 



620 PHYSIOLOGY. 

Describe hemoglobin and mention its derivatives. 

Hemoglobin is a proteid-like body, readily crystallizable 
and containing iron. It readily unites with oxygen and 
other gases and has a peculiar spectrum. On the addition 
of an acid or alkali, it is broken up into hematin and globin, 
a proteid of the globulin group. 

Hematin, hematoidin, hemin, hematoporphyrin and methe- 
moglobin are derivatives of hemoglobin. 

Define and give the physiologic significance of (a) dys- 
pnoea, (b) dysphagia, (c) apnoea. 

Dyspnoea, or difficult rapid breathing, is caused by a de- 
ficient supply of oxygen to the tissues. 

Dysphagia, or difficult or painful deglutition, may be 
caused by obstruction in the oesophagus, reflex spasm, or by 
painful affections of the pharynx. 

Apnoea, or cessation of breathing, is caused by the blood 
being overcharged with oxygen, or by a reflex inhibition of 
the respiratory center. 

What prevents digestion of the stomach by its own 
juices? 

The reason that the stomach is not digested by its own 
juices is not known, so it is said to be due to a vital act. 
Neither the alkalinity of the mucous membrane, nor the 
alkalinity of the blood will explain it. 

Give the physiology of (a) blushing, (b) pallor, (c) tear 
shedding. 

Blushing is a reflex dilatation of the bloodvessels of the 
skin. Some emotional disturbance so stimulates the vasodi- 
lator center in the medulla as to cause a vasodilatation of the 
skin vessels. 

Pallor is a reflex vasoconstriction of the bloodvessels of 
the skin. It is caused by a reflex excitation of the vaso- 
constrictor center in the medulla. 

Certain emotions so reflexly stimulate the lachrymal glands 
through the central nervous system as to cause the glands 



PHYSIOLOGY. 621 

to secrete more fluid than can be carried off through the 
nasal duct. The excess runs over the cheeks and is called 
tears. 

What causes (a) circulation of the blood, (b) the beat- 
ing of the pulse? 

The circulation of the blood is caused by the action of the 
heart, aided by the vasomotor system. 

The beating of the pulse is caused by the transmission of 
the cardiac impulse through the elastic arterial system. 

What are the functions of the pancreas? 

The pancreas secretes the pancreatic juice. In addition 
to this, it has an internal secretion, because extirpation of 
the pancreas causes diabetes. . 

What substances are absorbed principally in (a) the 
stomach, (b) the duodenum? 

Alcohol, water and soluble salts are absorbed in large 
quantities by the stomach. The fats, proteids and glucose 
are absorbed in the duodenum and in the rest of the small 
intestines. 

Describe the conditions within normal physiological 
limits which increase arterial blood pressure. 

Anything that will directly or indirectly cause stimula- 
tion of the vasomotor center will cause an increase in arterial 
pressure. 

Among these causes we have digestion, muscular exercise, 
various emotions, as fear and joy, increased resistance in the 
capillary system, dyspnoea and asphyxia. 

Name the inorganic proximate principles that enter into 
the formation of the human body. 

The inorganic proximate principles entering into the for- 
mation of the human body are water and the various salts, 
as sodium chloride, potassium sulphate, calcium fluoride and 
magnesium phosphate. 



622 PHYSIOLOGY. 

What do you understand by the term nutrition, and 
what processes are comprised under it? 

By nutrition is meant the taking in of nutrient material, 
its conversion into living protoplasm, and the throwing off 
of waste matter from the cell. 

It includes digestion, absorption, metabolism and excretion. 

What are the Wolffian bodies? When do they appear 
and into what organs do they ultimately develop? 

The Wolffian bodies are the temporary kidneys of early 
intrauterine life, appearing about the third week. In the 
female they become the parovarium; and in the male, form 
the globus major, vas efferentia and coni vasculosi. 

Name the functions of the chorda tympani, sufficiently 
detailing each to clearly define its character. 

The chorda tympani contains the vasodilator fibers, but 
no vasoconstrictor fibers, for the anterior tongue and sub- 
maxillary gland. It contains the secretory fibers to the sub- 
maxillary gland, and also the taste fibers for the anterior 
two-thirds of the tongue. 

Name the groups of food stuffs constituting the source 
of muscular energy. Designate the most important and 
state what stored product is utilized. 

Carbohydrates are the most important, but fats and pro- 
teids may be used in the production of muscular energy. 
Glycogen is the stored product that is utilized. 

State the function of the nervus opticus, and explain 
by description or diagram, the distribution of the fibers 
composing the chiasma and the effect thereof upon vision. 

The nervus opticus is the nerve of the special sense, sight. 

At the chiasma, the inner half of each optic nerve crosses 
to the opposite side ; therefore, in loss of function of one optic 
nerve from injury or pressure back of the chiasma, there is 
blindness of the temporal side of retina of the same eye 



PHYSIOLOGY. 623 

and of the nasal side of opposite eye. Stimulation of one 
retina by light causes a reflex contraction of both pupils. 

Describe metabolism. 

Metabolism is the chemical change going on in organized 
tissue. There are two divisions, — anabolism or building up, 
and katabolism or tearing down. This chemical change is 
usually a hydration, dehydration, reduction or oxidation. 

In the metabolism of proteids of the tissue, proteid food 
must be used to repair the loss. 

The carbohydrates are the substances most readily broken 
up to supply heat and energy, the fats being next in order. 
The salts are needed in the various processes, but especially 
to combine with the acids, sulphuric and phosphoric, formed 
in proteid katabolism. 

What is the normal proportion of blood in the human 
body and how is it renewed after hemorrhage? 

About one-thirteenth of the body weight is blood. The 
water and other constituents of plasma are renewed from the 
ingested food. The corpuscles are renewed by the bone mar- 
row, spleen and lymphatic tissues. 



HYGIENE. 



Mention eight satisfactory disinfectants and give indi- 
cations for their use. 

Formaldehyde (1 pound of formaline for every 1000 cu. ft. 
of space), sulphur (3 pounds for every 1000 cu. ft. of space) 
or bleaching powder (3 pounds for every 5000 cu. ft. of space) 
to fumigate a room. If sulphur or bleaching powder are 
used, it is necessary to steam the room before beginning to 
fumigate. Chloride of lime to disinfect excrementitious mat- 
ter from typhoid fever, cholera, dysentery, etc. Carbolic 
acid (5% solution) or moist heat (steam and boiling water) 
to disinfect clothing. Bichloride of mercury or permanga- 
nate of potassium and oxalic acid to disinfect the skin. 

What are the most common sources of infection in diph- 
theria? 

By direct contact with the sputum or shreds of membrane 
from the patient. By inhaling the air in the vicinity of the 
patient. By fomities, as clothing, books, drinking-cups, etc. 

What conditions are essential to a good water supply? 

Purity at its source, and adequate subsequent protection 
from contamination. 

What hygienic measures should be observed by the 
nursing woman? 

An abundant diet; avoiding overfeeding; some form of 
outdoor exercise each day; monotony of life and overwork 
should be guarded against. Warm clothing, personal clean- 
liness, abundant sleep, freedom from mental cares, fright 
or anger are necessary precautions. Each time the child is 
40 ( 625 ) 



626 HYGIENE. 

removed from the- breast the nipples should be washed with 
warm water and thoroughly dried. 

What precautions should a physician observe to avoid 
carrying contagious diseases? 

A linen duster and a tightly fitting linen cap should be 
worn by the physician in the sickroom, and be removed after 
leaving the room. Immediately after manipulating the 
patient the physician should thoroughly wash and disinfect 
his hands and face. A bath and change of clothing before 
attending other patients are advisable. 

Describe the hygiene of the mouth and teeth. 

The teeth should be cleansed after each meal and on rising 
in the morning, and foreign matter between the teeth should 
be removed. Acidity of the saliva may be counteracted by 
weak alkaline mouth washes. 

What methods would you suggest for the hygienic care 
of the skin? 

Simple foods; avoiding constipation; daily exercise in the 
open air; plenty of sleep (at least eight hours daily) ; frequent 
warm baths and a cold sponge bath on rising each morning. 

What localities should be sought or avoided by rheu= 
matic patients? 

Warm, dry, equable climate should be sought. Alkaline 
or sulphur thermal springs are recommended. Damp val- 
leys, shores of rivers, sea coasts and places which are much 
exposed to winds and sudden changes of temperature should 
be avoided. 

Name the kinds of food and the quantity of each for the 
daily use of the normal man. 

4.5 ounces of proteids; 3.5 ounces of fats; 14 ounces of 
carbohydrates; 1 ounce of salts (Moleschott) . Or 118 grains 
proteids; 56 grains fats 500 grains carbohydrates (Voit). 
These quantities represent dry foods. If the diet is stated as 
so-called solid-food (not water-free) the above quantities must 



HYGIENE. 627 

be doubled. 50 to 80 ounces of water in liquid form are 
also taken into the system. 

What is the object of the wet pack, and what unfavor- 
able results may occur from its use? 

The cold wet pack is used to lower temperature during 
fever. The warm wet pack is used to promote elimination 
of fluid, to relax muscular spasm, to promote sleep, and raise 
lowered vitality. 

The dangers to be guarded against are heart failure or 
fatigue, or excitement to weak patients. The cold pack may 
give the patient a nervous chill. 

Describe in detail the process of disinfection by formal- 
dehyde (formalin). 

Make the room as near air-tight as possible by closing all 
openings and cracks before beginning the process of disin- 
fection. All mattresses, pillows, clothing, books, etc., should 
be exposed as fully as possible to the action of the disinfect- 
ant. Place one pound of formalin for every 1000 cu. ft. of 
air space in a " Novy " generator. Start the rapid volatil- 
izing of the formaldehyde and allow the room to remain 
closed for one day. 

What hygienic means should be employed by persons 
prone to " catch cold?" 

A cold sponge bath followed by brisk rubbing on arising 
in the morning ; daily muscular exercise in the open air and 
a liberal (but not excessive) diet, largely of carbohydrates. 

Describe the necessary sanitary precautions during the 
prevalence of an epidemic of Asiatic cholera. 

Isolate all patients and attendants; observe strict quaran- 
tine of infected houses or districts ; disinfect and remove any 
accumulations of filth, excreta, etc. ; cremate those who have 
died from this disease. The water supply should be guarded 
to prevent its contamination; and insist upon householders 
boiling all water or milk before using the same. All gastric 



628 HYGIENE. 

or intestinal diseases should be attended to at once. Restrict 
or prohibit the use of all fruits or uncooked foods from the 
district; and use all disinfectant precautions where cases 
exist, during continuance of case, and after its termination. 

What are the sanitary requirements of house plumbing? 

All pipes and connections, traps, etc., should be in view or 
easy of access. Each house must be directly connected by 
pipe with the common sewer. The pipes in the house must 
be of iron with leaded joints or screwed couplings. The 
drainage pipes should be laid with a gradient of at least one 
inch fall to every four feet of length; the main house drain 
must be provided with a trap after it has been carried beyond 
all house connecting pipes. Pipes from water closet fixtures, 
bath tubs, wash basins and sinks must have traps close to each 
fixture. Soil pipes must extend open for at least two feet 
above the roof and air must -be admitted to the main trap 
upon its house-side. 

Describe a simple form of ventilating the sickroom. 

Place a wooden strip about three inches wide and as long 
as the window frame under the lower sash; through the 
space between the top of the lower sash and the bottom of the 
upper, sufficient air will enter the room without producing a 
draught. 

What precautions should be taken in school rooms to 
protect the sight of scholars? 

Pupils should not sit facing the windows (the light should 
come from behind or over left shoulder) ; blackboards should 
not have a glossy surface and should not be placed between 
windows. The walls of the room should be of a neutral tint. 
Text books should be printed in clear, large type. Faulty 
posture in reading and writing should be corrected by the 
teacher. If toilet accessories are supplied no child suffering 
with an inflammatory disease of the eyes should be permitted 
the use of the general supply. Any imperfection in vision 
of a pupil should be reported to the parents. 



HYGIENE. 629 

What are the chief sources of contamination to drinking 
water? 

The emptying of sewage into the stream from which the 
supply is obtained; surface water in settled districts gain- 
ing entrance to the supply; sub-soil water, after passing 
through a filthy soil; drainage from places of burial; and 
water which has dissolved poisonous minerals. 

Describe the several methods of purifying drinking 
water. 

Sedimentation, occurring when collections of water remain 
at rest for a considerable time, removing, in part, at least, 
suspended matter. 

Sand nitration in which the water flows upon and through 
prepared beds of sand, gravel and broken stone, packed in 
separate layers removes from it not only suspended matter, 
but also dissolved organic matters and bacteria through the 
action of air (oxygen) in the interstices of the filter material, 
and the action of saprophytic bacteria. 

Boiling water will free it of pathogenic bacteria and tem- 
porary hardness, but such water after boiling should be 
aerated to fit it for use. 

What do you understand by the " dry earth system " as 
applied to excrementitious matter? 

The container under the privy seat contains the dry earth, 
and after the use of the privy fresh earth is always to be 
added to the receptacle. From time to time the contents are 
removed and buried or otherwise disposed of. 

Contrast the incubative stages of measles and scarlet 
fever. 

The stage of incubation in measles is from one to three 
weeks (average 12 days) ; in scarlet fever from one to eight 
days (average 3 days). 

Mention some of the results of tobacco smoking in 



630 HYGIENE. 

growing; school boys in respect to the circulation, air 
passages, vision and mental application. 

It depresses the circulation and produces palpitation of 
the heart. It causes low grades of inflammatory processes 
in the upper air passages, catarrhal conjunctivitis, mental 
lethargy with inability to sustained mental application. 

What habits of school children tend to produce myopia? 

Reading of small or imperfect print ; faulty positions while 
reading or writing in which the eyes are not far enough re- 
moved from the page ; reading or writing in insufficient light, 
or when fatigued. 

What should be the proper temperature for a living 
room in winter? 

72° F. for old or weak persons; 65° F. for the young and 
vigorous. 

What should be the diet of a child over two years of age? 

The food should consist principally of milk and bread with 
rice, tapioca, some vegetables of easily digestible character 
and sparingly of fruit, preferably cooked; but little meat 
should be allowed, and this preferably mutton. 

What hygienic precautions should be observed by a 
pregnant woman? 

Diet should be nutritious ; clothing should be loose ; moder- 
ate outdoor exercise should be taken each day; the marital 
relations should cease; the action of the skin should be 
stimulated by warm baths. After the sixth month the urine 
should be examined every few weeks. Constipation should 
be corrected by hygienic measures when possible. In late 
pregnancy the nipples, if necessary, may be developed by 
judicious manipulation. 

What is the most sanitary way of disposing of city 
garbage? 

Burn it, so that all noxious vapors are also consumed. 



HYGIENE. 631 

Mention six desirable factors in the location of a resort 
for consumptives. 

Equable climate, high altitude, dry atmosphere, pure air, 
abundant sunshine and pine forests are climatic factors for 
consumptives. 

State the accepted belief in respect to the limitation of 
protection from vaccination. 

Five years, when revaccination should be attempted. Dur- 
ing a small-pox epidemic it is advisable to revaccinate all in- 
dividuals who have not been vaccinated within two years. 

Mention some of the adulterations in preparations of 
ground coffee for sale in the shops. 

Chicory, peas, roasted cereals and legumes, date stones, 
acorns, sawdust, etc. 

What class of foods should predominate for persons 
over sixty years of age? 

Use eight-tenths the quantity of proteids that the vigorous 
adult requires; seven-tenths the quantity of carbohydrates; 
and one and two-tenths times the quantity of fats. 

Which in your judgment is to be preferred in vaccina= 
tion, animal or humanized lymph, and why? 

Animal lymph because in its preparation greater care may 
be taken to secure its freedom from deleterious additions. 

Name some of the nuisances dangerous to health. 

Gases and dust of a poisonous or irritating nature arising 
from many manufacturing industries. Collections of stag- 
nant water, garbage and animal excreta exposed to air; 
leaking drains or sewers saturating the soil, or allowing the 
escape of gases. Industries giving rise to great noise or 
vibration in thickly settled communities. 

What is the best means for preventing the access of 
sewer gas in dwellings? 

Place a trap or water seal between the house drain and the 



632 HYGIENE. 

sewer and provide an air inlet pipe to open into the drain 
pipe between this trap and the house. A ventilation pipe 
should extend from the house drain to a point above the roof. 

State the ordinary death rate of each of four cities 
having respectively a population of more than fifty thou- 
sand (50,000). 

Dublin, 39.9 ; St. Petersburg, 31. ; Berlin, 17. ; Amsterdam, 

17.8 (1897). 

Name the diseases the predisposition to which is greatly 
increased by the habitual use of alcohol. 

Diseases of the heart and vascular system, the kidneys, 
brain and liver and of the respiratory system, particularly 
pneumonia and asthma. 

Mention methods to be employed for preventing epi- 
demics of yellow fever in the tropics. 

Remove at once to high or new ground should the disease 
appear. Cremate all those who have died of the disease; 
disinfect and remove all filth and endeavor to destroy all 
mosquitoes and their larvae, and other insect pests by the 
use of petroleum, subsoil drainage of damp places, and filling 
all stagnant pools with clean dirt. 

Name four diseases that are communicable to man 
through cows' milk. 

Typhoid fever, scarlet fever, cholera and tuberculosis. 

To what is indigestion from excessive tea drinking 
attributable? State a formula for the preparation of 
good tea. 

The indigestion is caused chiefly by tannin; also by theo- 
bromin. 

Pour one pint of boiling water over a dram of the dried tea 
leaves and allow it to stand without applying further heat 
for five minutes. 



HYGIENE. 633 

Mention some of the advantages of carefully prepared 
artificial ice as compared with natural ice. 

It may be made from distilled water so as to be absolutely 
pure. It may be obtained in any size or shape and its texture 
is more uniform. 

What precautions as to food and drink should be ob- 
served by those forced to work under the direct rays of 
the sun in summer weather? 

A small quantity of readily digestible food should be eaten 
before going to work. Liquids of a nonalcoholic character 
may be used liberally, provided perspiratory function is 
actively performed. Very cold drinks should be avoided. 
Meat should be largely excluded from the diet. 

A law to prevent owners of land in the narrow streets 
of New York city from erecting buildings more than 
twelve stories in height is being agitated. Give sanitary 
and hygienic reasons for and against. 

Reasons favoring tall buildings : The persons using the 
upper floors are insured uninterrupted sunshine, good light, 
a pure air, comparatively free from street dust, and free- 
dom from ground air and water. 

Reasons against: Tall buildings prevent proper ventilation 
of lower buildings, and obscure sunlight from smaller build- 
ings and the street. Fire is difficult to extinguish in tall 
buildings. Their lower floors are often damp and generally 
dark, requiring the constant use of artificial illumination. 
They are, therefore, a menace to the lives of their occupants. 

What are the best methods of ventilating dwellings, 
and what sanitary principles are involved? 

The perflating action of wind should be utilized at least 
once each day for all rooms. One of the best methods em- 
ployed is the open fireplace, provided such fireplaces be sup- 
plied with properly constructed chimney exits. In lieu >f 
this plan fresh air may be admitted through ventilators, or 
between the upper and lower window sashes. The object 



634 -HYGIENE. 

sought in these devices is to admit cold air above the heads 
of the occupants of the room so that the fresh air may pass 
through the upper portions of the room and become heated 
before reaching the occupants. The usual outlet for foul air 
is the chimney flue, but when this is not present, it may be 
replaced by an opening for the exit of air placed near the 
floor of each room. When the incoming air is not heated the 
outlet should be at the top of the room. During cold weather 
the rate of interchange of air should not be greater than 
sufficient to change the air of the room three times an hour. 
The air which enters should not have a greater velocity than 
five feet per second or about 3.4>miles per hour. 

What hygienic precautions should be observed in the 
care of the new=born child? 

The room should be kept at a temperature of about 72° 
Fahr. and well ventilated without draught. The child should 
be thoroughly cleansed, using a neutral fat to facilitate the 
removal of all fatty or sebaceous material before washi'i^ 
with warm water and castile soap. The eyes and surrounding 
parts should in particular be thoroughly cleansed ; if possible, 
without the aid of soap. After thoroughly drying the infant, 
its navel should be properly dressed. The infant should 
then be warmly clad, kept dry and clean, and away from 
noise and strong light. 

What hygienic precautions are necessary to insure 
healthy sleep? 

A well ventilated room, temperature about 60° F. Room 
and bed should be perfectly clean, and the covers of the bed 
not too heavy. The head of the person should be slightly 
elevated. Noise and light should be excluded from sleeping 
apartments. 

What deleterious gases accumulate in improperly ven- 
tilated sleeping rooms? 

Carbon dioxid; carbon monoxid, if rooms be heated; hy- 
drogen sulphid; ammonium sulphid, and many gases of an> 
organic ammoniacal character. 



HYGIENE. 635 

Does change in climate require any change in food, if 
so, what? 

Yes. In cold climates a greater quantity of food should 
be consumed than in hot climates. Food that is productive 
of the greatest number of heat units, as fats and meats, 
should be partaken of in cold climates. In hot climates the 
diet should consist almost entirely of well-cooked vegetables 
and ripe fruits; with the avoidance of alcoholic beverages. 

What are some of the dangers of the cold bath? 

In those of feeble circulation and at the two extremes of 
life, chilling of the surface of the body leading to internal 
congestion that may result in acute inflammation, particu- 
larly of the lungs, kidneys, stomach and bowels. Shock 
seriously affecting the heart; and the production of a per- 
sistently lowered temperature of the body. 

What effect has ground air and water on the health? 

Ground air is always impure, being contaminated with 
bacteria, carbonic dioxid and often with more poisonous gases. 
It occasions various degrees of ill-health, varying from slight 
general malaise to one of the acute infectious diseases or 
tuberculosis. Ground water from near the surface of pol- 
luted soils may be noxious. It causes dampness of the walls 
of houses, inviting rheumatic diseases and catarrhal inflam- 
mations. 

What hygienic principles should be observed in infant= 
feeding? 

Feed the child every two hours during the day, and about 
three times during the night till several months old ; then less 
frequently. If possible let the child receive its natural food 
from the mother, and in such cases take particular pains to 
see that the nipples and breasts of the mother are kept dry 
and clean between the times of nursing. If the infant is to 
be given artificial feeding the cow's milk selected must be 
from a healthy animal; must be diluted with water to give 
a relatively less proportion of casein ; must be sweetened with 



636 HYGIENE. 

milk sugar, and have a slight addition of fats in the form 
of cream added, when it will approach human milk in com- 
position. A definite quantity of milk which should be 
warmed to the temperature of the body should be given at 
each feeding. 

Define the word " nuisance " in a broad hygienic sense. 

" Something which either actually injures, or is likely to 
injure health, and admits of a remedy either by the individ- 
ual whose act or omission causes the nuisance, or by the 
local authority" (Wynter-Blyth). 

What should be the height, weight and chest measure 
of a typical man aged 25 years? 

Height 67.8 inches; weight 139 pounds; measurement of 
chest 34.5 inches. 

What injurious influences, if any, do cemeteries exert 
on the health of persons living in their vicinity? 

To most persons the mental effect is depressing. Water 
passing through the soil of cemeteries may contaminate the 
water supply of the neighborhood, with organic material and 
micro-organisms. The constant turning of soil of cemeteries 
may set free imprisoned gases from organic decomposition, 
and lead to contamination of the surrounding air. 

What physical conditions would render the taking of a 
Turkish bath inadmissible? 

Atheromatous arteries generally, diseases of the lungs, 
and diseases of the heart. 

What gases and combination of gases are most efficient 
as disinfectants? 

Formaldehyde, Sulphur dioxid, Chlorin, Ozone. 
What care should be employed in exhumations? 

The exhumation of those dead of contagious or infectious 
diseases should not be allowed. When possible, the exhuma- 
tion should be deferred until cold weather. The presence of 
all persons except those absolutely needed should be for- 



HYGIENE. 637 

bidden. As the workmen approach the coffin the earth should 
have poured upon it a strong watery solution ^)f creolin. 
The coffin containing the remains should not be opened, but 
be placed at once in a zinc lined box and hermetically sealed. 

What are the hygienic requirements and the physio= 
logical effects of bathing? 

The bath should be taken to obtain personal cleanliness, as 
well as for its stimulation of the peripheral circulation. 
Bathing should be postponed until at least two hours after a 
meal, and should consume only twenty minutes. Never 
bathe when very hungry, or when the body is overheated. 
Unless experience has shown that good effects accrue from a 
cold bath, secure a temperature of about 65 to 75 degrees 
Fahr. of the water. The bath should be followed by a 
thorough drying and brisk rubbing. Effects following a 
bath are removal of dirt and of dead epithelium from the 
person, stimulation of the functional activity of the skin; a 
general improvement in the circulation and increased func- 
tional activity of tire organs of elimination. 

How much fresh air is required for normal respiration 
during 24 hours? 

3000 cubic feet per hour or 72,000 cubic feet of air in 
24 hours. 

What is the best sanitary disposition of stable manure 
in large cities? 

The liquid portion of manure should be carried by prop- 
erly constructed trapped drains into the general sewer. The 
solid, dried manure, straw, etc., should be placed in well 
covered pits, from which it could be removed at proper in- 
tervals in covered wagons, and employed in the country as 
fertilizer; or drain the liquid manure into the sewer and 
cremate the solid manure. 

How may a privy in city or country be kept while in 
use from becoming a nuisance? 

Have the privy emptied at frequent intervals. At inter- 



638 HYGIENE. 

vals of five to seven days, pour into the privy vault milk 
of lime (about 20 grains of lime for each gallon of sewage), 
or strong solution of iron sulphate; or at frequent intervals 
add clean, dry earth to the privy contents, and provide a 
ventilating pipe extending high in the air and down into the 
privy vault. 

What explanation can be furnished for the greater 
prevalence of diphtheria and small=pox in cold than in 
warm weather? 

During cold weather the houses are less perfectly venti- 
lated than in warm weather. Rooms are frequently over- 
crowded, less attention is paid to personal cleanliness and 
there are more sudden changes in temperature. Such condi- 
tions lower the vitality of the body and predispose to disease. 

What are the principal adulterations of milk? 

Addition of water and abstraction of cream; addition of 
coloring matter (annatto, caramel) ; preservatives (borax and 
boracic acid, salicylic acid, formaldehyde, chromates) ; gela- 
tine as a thickening for cream. 

What changes in food are effected by cooking? 

Parasites and germs are destroyed; the food is made more 
tender to facilitate mastication. The tough fibrous envelope 
of starch cells is softened, albumin is coagulated, the food 
is rendered more palatable, and the action of the different 
digestive fluids is aided. 

Give the sanitary dimensions of a school room for fifty 
pupils. 

A room 15 feet high, 25 feet wide and 40 feet long would 
allow each pupil 300 cubic feet of space, which is the ade- 
quate amount for each child. 

State the advantages of cremation over earth burial. 

Complete destruction of specific disease germs. If crema- 
tion be well performed no obnoxious gases are given to the 
air, no gases of putrefaction contaminate the air, and there 



HYGIENE. 639 

is no danger of contaminating the water supply through, 
drainage from cemeteries. 

What measures, including diet and medication, should 
be used on shipboard or in camp to eradicate " scurvy "? 

Increase the supply of fresh fruits and vegetables. Give 
lemon juice, vinegar, fresh meat and iron tonic. Insist upon 
personal cleanliness, increase ventilation, and use astringent 
mouth washes. 

What are the respective merits of cotton, wool and silk 
when used as underwear? 

In a variable climate wool is preferable because from a 
larger amount of air enclosed in its texture it acts as a good 
non-conductor of heat, retaining the body temperature. As 
wool is hygroscopic it readily absorbs moisture from which 
it parts slowly, so preventing surface chill of the individual 
by too rapid evaporation. Next in order to retain the heat 
of the body we rank silk and least valuable for the retention 
of body heat is cotton. If it be our purpose to supply a cool 
garment we would of course reverse this order of arrangement. 

If a chemical analysis of water revealed the presence 
of nitrites and nitrates, would this condemn it for drinking 
purposes? If so, why? 

Yes, particularly if nitrates be present. Organic matter, 
particularly sewage, is converted first into nitrites, and 
these into nitrates through the action of bacteria in the soil-. 
These salts would, therefore, indicate a former pollution of 
the water with probably some of that polluted material still 
unchanged in the water. 

To what diseases are negroes comparatively insuscep= 
tible? In the Middle States to what diseases are negroes 
more prone than whites? 

Dysentery, yellow fever, and diseases incident to exposure 
to summer heat. Negroes are more prone than whites to 
contract small-pox, diseases of the respiratory tract, fibroid 
tumors, keloid growths and venereal diseases. 



640 HYGIENE. 

Give a medical and hygienic plan for the inspection of 
immigrants who have just arrived at a seaport. 

Examine the " Bill of Health " and clinical records of all 
cases treated during the voyage and the lists of passengers, 
crew and manifests, and, if desirable, the ship's log. Have 
crew and passengers mustered and compared with the lists, 
investigating any discrepancies and make a careful examin- 
ation of both crew and passengers. If a case of infectio.is 
disease has occurred during the voyage, disinfect all exposed 
baggage and freight and detain such members of the crew 
and passengers as have been exposed until the incubation 
period of the disease has passed. 

What conditions of ill health make residence in high 
altitudes dangerous? Why? 

Chronic Bright 's Disease, disease of the heart, emphysema ; 
and old age. High altitudes occasion increased respiratory 
effort from the rarified condition of the atmosphere, causing 
increased heart action, and a lessened perspiratory function. 

State the physical conditions that make the practice of 
taking hot baths inadvisable. 

Acute inflammatory diseases, tuberculosis, organic diseases 
of the heart and brain, aneurism, cancer, and all diseases in 
which stimulation of the circulation is to be avoided. 

State some of the sequelae of (a) over=strain, (b) over- 
exertion, (c) over=training. 

(a) Parting of continuity of osseous, ligamentous, muscu- 
lar or bloodvessel structure leading to fractures, dislocations, 
rupture of muscles, hernia, rupture of heart muscles, disease 
of valves of heart or apoplexy. 

(b) May produce same conditions as overstrain and in 
addition cause general muscular relaxation, dyspnea, syn- 
cope, etc. 

(c) Loss of appetite and of muscular power, successive 
crops of boils appear, individual loses mental power, as of 
concentration of thought, and digestive disturbances occur. 



HYGIENE. 641 

What constitutes hard water and soft water? 

"Hardness is the eapaeity a water has for decomposing 
soap, and depends on the amount of salts of magnesia and 
calcium in solution. ' ' (Harrington . ) 

Soft water contains little or no dissolved salts and rapidly 
forms a lather with soap. 

Mention the dangers of excessive shade about dwellings. 

Excessive shade interferes with the free movement of air, 
prevents penetration of the sun's rays, promotes dampness 
which is given off to the air by evaporation. It exerts a de- 
pressing mental action, promotes the growth of fungi and 
bacteria, and prevents the aspirating action of heat from the 
sun upon air and moisture in the soils. 

What is milk sterilization? How is it performed? 

Destruction of micro-organisms in the milk by heat. By 
continuous heating of the milk, under pressure, for two 
hours at 248° F. 

State the objections usually advanced against vaccina- 
tion as a preventive of small=pox. 

It is urged that it fails to protect from small-pox (which 
is false), that it may produce blood-poisoning, that constitu- 
tional diseases like syphilis, scrofula, etc., may be introduced 
by the vaccine virus, or in the operation. Also that tetanus 
may result, and that it is not right to deliberately inoculate 
a healthy person with the virus of vaccinia or of any disease. 

On what generally accepted theory are toxins used for 
the prevention and cure of disease? 

That their presence in the system renders the blood no 
longer able to support the lives of bacteria that occasion such 
toxins. 

What infectious diseases may be due to impure drinking 
water? 

Typhoid fever, malarial fevers, cholera, relapsing fever, 
dysentery, parasitic diseases. 
41 



€42 HYGIENE. 

Define humidity of the atmosphere. Why should a 
humid atmosphere cause rheumatic persons and persons 
suffering with the gout increased sensitiveness? 

The term humidity refers to vapor of water in the air. An 
increased humidity increases sensitiveness of gouty and rheu- 
matic patients by decreasing elimination from the skin of 
■excretory organic matters and uric acid derivatives and thus 
leading to retention of such poisons in the system. 

What constitutes a thorough meat inspection? How 
should an inspection of milk be conducted? 

Meat should be inspected within 24 hours after the animal 
is killed. The following points are noted: The quantity of 
bone, for which 17 to 20 per cent, is to be allowed. The quan- 
tity and character of the fat, noting its color, consistency, 
and taste. Condition of the flesh. Condition of the marrow. 
Examination of the lungs, liver, kidneys for detection of in- 
fectious disease manifestations. A microscopical examination 
of the flesh for detection of bacteria of pathogenic character, 
trichina, tape worm or other parasites. Where possible, it 
is well to investigate the surroundings in which the animal 
has lived and the methods employed for storage and re- 
frigeration. 

An inspection of milk takes cognizance of its specific grav- 
ity, color, quantity of cream, presence of preservatives, pres- 
ence or absence of dilution, or addition of coloring matter, 
determination of total solids, of quantity and quality of ash, 
of fats, casein, lactose. The microscopical and bacteriologi- 
cal examinations are performed and finally an examination 
is made of the source, storage and distributing methods. 

Discuss the theory of hereditary tendencies as applied 
to tuberculosis. 

Children born of tuberculous parents present less power to 
combat and overcome the attacks of the tubercle bacilli than 
others of more healthy parents. Some theorists claim that 
this deficiency of resistance is in part due to an inherited 



HYGIENE. 643 

small heart, and lessened circulatory power, thus favoring 
conditions of passive congestion or slow grades of innamnia- 
tory processes. Such subjects as a rule show lessened lung 
expansion, a flattened or a wedge-shaped chest, etc. 

Describe the physiological action of alcohol. 

Small or therapeutic doses increase the pulse rate and the 
.arterial pressure by directly stimulating the heart. Over- 
doses directly depress and paralyze the heart muscle. Large 
doses produce decided lowering of body temperature. It is 
probable that the use of alcohol diminishes the elimination of 
C0 2 . Alcohol causes a great lessening in the excretion of the 
products of tissue waste. It is probable that alcohol in not 
too large quantity is entirely destroyed in the body. In 
small doses alcohol acts as a cerebral stimulant, while larger 
doses greatly depress and abolish nervous activity, and check 
digestion. The habitual use of alcohol is accompanied by a 
disposition towards fatty degeneration, particularly of heart 
muscle, liver and kidneys, and an enlarged and dilated con- 
dition of the smaller bloodvessels and a degeneration of all 
nervous structures. 

Does alcohol possess a food action? On what do you 
base your answer? 

Yes. ' '. In the sense that it is destroyed in the system and 
yields force which is utilized by the organism, and is when 
in sufficient quantity a retarder of tissue change, checking 
the excretion of nitrogen " (H. C. Wood). We see this in 
its administration in typhoid and other long continued fevers. 
Yet it is not a true food, since it also exerts toxic effects, 
which foods do not. 

State your views on compulsory vaccination and relate 
the safeguard that should be employed in all cases of 
vaccination. 

The unprotected individual should be vaccinated as a pro- 
tection to himself and to those with whom he comes in contact. 
The virus employed must be free from contamination, and 



644 HYGIENE. 

the instruments used should be perfectly sterile, and the 
operation should be performed on a clean surface. The 
wound should be adequately protected from irritation by 
clothing or from pathogenic germs. 

In the pursuit of what trades is there a predisposition 
to pulmonary diseases? 

Trades carried on in overcrowded, poorly ventilated rooms, 
in damp localities. Trades that give rise to much dust, par- 
ticularly if such dust be of fine hard particles to which file 
makers, stone cutters, grinders, etc., are subjected. Such 
trades as necessitate cramped positions of the workers pre- 
venting proper lung expansion. In vocations giving rise to 
poisonous or obnoxious vapors, and also where the individual 
is exposed to sudden changes of temperature. 

Under what condition is tyrotoxicon found in milk, 
cheese and other articles? 

Where mi lie, cheese, ice cream, etc., undergo decomposition 
in the presence of other organic matter, as rotting wood, 
mould, etc. 

The excavation of streets in cities is frequently fol= 
lowed by the outbreak of disease, such as diphtheria, 
typhoid fever. What is the cause? 

Pathogenic bacteria lie dormant in the soil of cities, and 
when such soil is exposed to the air, it becomes dried, and 
its contained bacteria taking on an active existence are 
liberated and carried by the air to susceptible individuals. 

Describe the agency of the ptomaines in inducing dis* 
eases and the disorders produced by them. 

Ptomaines are alkaloidal bodies resulting from decomposi- 
tion of nitrogenous substances. When absorbed into the 
blood they may give rise to fever, headache, torpor, fetid 
breath. They act like chemical poisons very soon after their 
introduction into the system. Many of them occasion dis- 
tinctive trains of symptoms. 



HYGIENE. 645 

How long does a diphtheritic patient remain infective? 
How may it be proved that this infective period has 
ceased? 

About three weeks after local symptoms cease. Make fre- 
quent cultures of material from the affected site, and when 
such fail to show the specific germ, the patient will no longer 
be a source of infection. 

How may milk be the means of transmitting the germs 
of typhoid fever? 

Through water containing Eberth's bacillus gaining access 
to the milk, as through diluting the milk, washing milk re- 
ceptacles in polluted water. 

State the period of incubation in (a) vaccinia; (b) paro- 
titis; (c) pertussis; (d) varicella; (e) rotheln. 

(a) 3 to 7 days; (b) 14 to 22 days; (c) 2 to 8 days; (d) 4 
to 14 days; (e) 12 to 20 days. 

Mention the effects of working in phosphorus, as in the 
manufacture of phosphorus matches. How can the dan- 
gers be limited or prevented? 

Inhaling phosphorus fumes produces a form of necrosis of 
the jaw, particularly in such as have imperfect teeth. To 
avoid its development persons with sound teeth and freedom 
from abrasion of the interior of the mouth should be em- 
ployed. The work room should be large and well ventilated, 
with special air shaft to force the fumes away from face of 
workers, the employes should have short working hours, and 
frequently use a mouth wash and gargle of lime water or 
carbonate of sodium. Turpentine and charcoal should be 
exposed in the room. 

What fruits are preferable in cases of habitual consti- 
pation? 

Apples, prunes, figs, tarmarinds, grapes and melons. 



646 HYGIENE. 

Indicate a proper diet in the case of diabetes mellitus, 
obesity and early convalescence in typhoid fever. 

The diabetic should use only a small quantity of carbo- 
hydrate foods with a relatively large quantity of proteid 
foods and fats. The patient suffering from obesity should 
use but little fluids or food containing much water. Food 
containing starch and sugar should be eaten sparingly, and 
alcoholic liquors and fats must be avoided entirely. He 
should eat lean meats, mutton, beef, lamb, chicken, eggs, stale 
bread or toast sparingly, tomatoes, lettuce, celery, asparagus, 
onions, ripe fruits of an acid nature but no sugar. 

In convalescence from typhoid fever the patient should use 
easily digestible food of a concentrated, nourishing character, 
of small bulk and without hard, or irritating properties, as 
soups, broths, uncooked oysters, eggs, rice, wine, milk, calves r 
foot jelly, etc. 

What is the chief unsanitary condition of sea=going 

vessels? 

The presence of bilge water and a dirty hold. 

Describe the manner in which antitoxin is prepared. 

A virulent culture of the specific micro-organism, or a 
strong toxin is injected into the cellular tissue of the selected 
animal, under due precautions of aseptic operation. After 
the animal has recovered from the symptoms thus produced, 
another and stronger injection of the specific poison is given. 
Injection after injection of increasing strength is given at 
proper intervals, until the animal fails to show any further 
symptoms of the disease, — after an injection. Blood is then 
taken from the jugular vein of the animal, the greatest care 
to secure aseptic conditions being observed. This blood re- 
ceived in sterilized flasks, which are then stoppered, is stored 
in refrigerators until separation of clot and serum occurs. 
The serum is now tested to determine its value as antitoxin 
and then, after the addition of a very small proportion of 
carbolic acid, is placed in small vials which are then hermeti- 



HYGIENE. 647 

cally sealed. Each vial has marked upon it its strength in 
units of normal antitoxin units in each cubic centimeter, 
and usually contains one dose. 

Mention some of the objections to curbed or driven 
wells in streets or houses with respect to the purity of 
water coming from these wells. 

The curbing rarely affords protection to the well water 
from gases and other emanations from sewers, gas pipes, 
drains; etc., and even though a driven piped well may take 
its water from far below the surface, yet in the streets of 
cities, with the ever present sewer and gas pipes, the soil 
becomes so saturated with deleterious material as to greatly 
endanger, through water carriage, the water from all forms 
of wells. 

From what disease may immunity be acquired in the 
case of persons who have once suffered from these dis- 
eases? How is knowledge of this fact utilized in the 
prevention of certain diseases? 

Yellow fever, small-pox, scarlet fever, measles, mumps, 
chicken-pox, pertussis, typhus fever, typhoid, cholera. 

We may prevent some of these diseases by the introduction 
into the patient's system of the particular antitoxin of the 
threatened disease. 

Describe the effect of a hot and moist climate on the 
human system, and state the class of diseases this atmos= 
phere is likely to induce. 

In hot and moist climates the inhabitants, as a rule, are of 
small stature and deficient in muscular development; of lan- 
guid disposition and nervous temperament. The diseases 
most prevalent are those affecting the liver and gastrointes 
tinal tract ; also various forms of malarial disease and yellow 
fever. 

What occupations are a menace to public health? Why? 

Those occupations that emit irritating, poisonous or noxi- 



648 HYGIENE. 

ous fumes and gases from the vitiation of the atmosphe e, 
as in fertilizing plants, chemical manufactories, bone-boiling 
establishments; also such occupations as give rise to much 
dust, especially if this be of sharp, hard character, as from 
cement making, tool making, in which the respiratory tract 
is subjected to irritation. 

Mention some of the objections to storage cisterns under 
ground. What are the objections to rain water as a drink? 

They often receive dust and dirt; sewer gas may gain 
entrance to the water when the " standing waste " or over- 
flow pipe of such a cistern is connected with the drain or 
soil pipe of a house. Storage cisterns cannot be properly 
ventilated, and are often difficult to clean. 

If the first part of the rain be collected, such water will 
contain dust, pollen, gases and other matters washed from 
the air. 

Mention some of the diseases to which artisans are 
especially liable. 

Painters and those working in lead, copper and zinc may 
suffer from metallic poisoning; match-makers from phos- 
phorus or sulphur poisoning; tool-makers and grinders from 
phthisis ; miners from affections of bronchi and lungs ; smelt- 
ers from arsenical poisoning. 

Give an opinion as to the sanitary effect of the different 
methods of heating houses. 

The most desirable method is by Hot Water Heating by 
means of a complete plant with circulation of the hot water 
through radiators. Next in value to hot water heating is 
steam heating by radiators or by indirect radiation. The use 
of open fireplaces in the principal rooms is of great value in 
securing ventilation, but yields an unequal and insufficient 
supply of heat. Heating a house by hot air from basement 
heaters is efficient and gives good results, if the air supplied 
to the heater for distribution is pure and the house is not 
too large. 



HYGIENE. 640 

State the average weight of feces in 24 hours in a nor- 
mal man. What proportion is made up of liquid and what 
of solid contents? 

Six ounces, 75 per cent, of which is water. 

Name eight principal carbohydrates used as food. 

Starch, glucose, saccharose, lactose, dextrin, cellulose, 
maltose and dextrose. 

Name the class of foods which should be given to chil- 
dren between the first and second years of age. 

We should supply foods in about the proportion of 2 parts 
proteid, 3 parts fat, 6 parts carbohydrates, the proteid food 
preferably milk. 

How do forests benefit public health? 

Forests act as wind barriers, promote humidity of the air 
from the widespread surface they offer for evaporation. 
They afford shade in summer, and aid in decreasing the re- 
lative quantity of carbon dioxid in the air, exhaling oxygen to 
the air. 

State in a general way the maximum number of hours 
that primary pupils in the public schools should be kept 
at their tasks, and how frequently and in what manner 
such tasks may be varied and broken? 

One half hour at a given task is sufficient, when the char- 
acter of the mental work should be changed. When an 
hour's mental application has been enforced, then five or ten 
minutes should be given to light calisthenics. An intermis- 
sion of fifteen or twenty minutes in the open air should 
occur in the course of three hours study. An intermission 
of two hours should then be allowed for luncheon and re- 
creation, at the end of which time a similar routine may be 
followed, as stated above, for two hours. 

What abnormal condition of the eye is most common 
in school children? 

Myopia. 



650 HYGIENE. 

What are some of the dangers involved in the domestic 
use of ice? 

Ice may contain pathogenic bacteria, and may, when re- 
moved from a sick room transmit infections disease to other 
members of the household. 

What is the expectation of life of a professional man 
in active practice at the age of 45 years? 

24.82 years. 

Define the term " quarantine," mention the principal 
quarantinable diseases, and give the rules for determining 
the length of time each should be quarantined. 

" The adoption of restrictive measures to prevent the 
introduction of diseases from one country or locality into 
another. ' ' ( Wyman) . 

- Quarantinable diseases include cholera, small-pox, yellow 
fever, plague, scarlet fever, diphtheria, typhus fever, relaps 
ing fever, cerebro-spinal meningitis, leprosy. 

In eruptive fevers isolation of the patient (quarantine) is 
continued for two weeks after the eruption has disappeared 
except in the case of small-pox where quarantine lasts 30 days. 

The quarantine in diphtheritic cases does not cease until 
cultures made from the throat of the patient fail to show 
the bacillus of diphtheria. 

State the best means of disinfecting sputum. 

Sputum should be burned or be received into vessels con- 
taining strong antiseptic solutions. 

What is understood by the germ theory of disease? 
Mention all diseases whose causes are known to be specific 
microorganisms. 

The germ theory of disease contends that the exciting 
cause of each infectious or contagious disease is some specific 
organism, and that these diseases are communicated only by 
the transference to and development of the particular para- 



HYGIENE. 651 

site or germ within or upon the tissues of the infected in- 
dividual. 

Diseases due to specific micro-organisms are tuberculosis, 
diphtheria, cholera, typhoid fever, dysentery, pneumonia, 
glanders, leprosy, anthrax, erysipelas, gonorrhea, relapsing 
fever and tetanus. 

What diseases are incident to school life? How may 
these diseases be prevented? 

The infectious diseases, which should be prevented by early 
recognition and prompt removal of sick pupils. The room 
should be disinfected. Curvature of the spine should be cor- 
rected or prevented by properly constructed school furniture, 
and proper admission of light to the room. Myopia should 
be prevented by the use of clear, large print in text books 
and correction of improper positions in reading and writing, 
and a good supply of light admitted to the school room to 
the left of the pupils. 

Contagious conjunctivitis, prevented by cleanliness and 
isolation of the patient. 

Chorea, prevented by removal of the afflicted and repres- 
sion of all the tendencies toward imitation. 

What is the value of preventive inoculation in cholera 
and diphtheria? 

Value in cholera not yet fixed. In diphtheria, antitoxin is 
both curative and prophylactic. 

Outline the construction of a camp hospital, especially 
providing for the care (with least danger to other patients, 
medical and surgical) of those suffering from contagious 
diseases. 

Obtain purity of internal atmosphere; abundance of pure 
air and sunlight within the building, facility of administra- 
tion and discipline. To obtain these requirements select a 
proper site of soil, not clay and preferably on hillside look- 
ing southward if in winter; use a simple plan of building, 
a sufficient number of wards, preferably on the detached or 



652 HYGIENE. 

pavilion plan. In wards each patient should have at least 
90 square feet of surface space, and 1200 cubic feet of air 
space; have provisions for burning all infected material, dis- 
charges, etc., to leeward of the hospital and at a suitable 
distance away. 

Can it be proved that the diminished death rate from 
diphtheria so generally announced is due to the use of 
diphtheria antitoxin? Give reasons. 

Yes. By comparing the death rate in hospitals treating 
the same class of patients, in the same community, during the 
same time, the one hospital using diptheritic antitoxin, the 
other depending upon other methods of combatting the dis- 
ease. Where the antitoxin is used the death rate is much 
lower. 

Give the comparative nutritive value of sterilized or 
unsterilized cows' milk. 

The nutritive value of sterilized milk is less than of milk 
unsterilized. 

What evil consequences frequently result from the 
excessive use of tobacco? 

Catarrhal inflammation of pharynx, tonsils and mouth. 
Nervous disorders of heart as palpitation, and insomnia also 
result. Derangements of stomach with loss of appetite, and 
impairment of vision together with paralysis of optic nerve, 
nervous tremors, and muscular twitchings may result. 

How should a patient who has been rendered uncon- 
scious by heat be treated? 

If the patient has a strong, full pulse and the face is red 
and congested, place him in a recumbent position with the 
head raised and apply ice until the high temperature falls 
to about 100 degrees Fahr. 

If the patient is pale, with a weak pulse use stimulants, as 
ammonia, by inhalation; apply heat to the body and keep 
head, face and neck cool. 



HYGIENE. 653 

State the value of public baths to the health of a large 
city. 

They give facilities to the poor for obtaining personal 
cleanliness, exerting a protective influence over the develop- 
ment and spread of filth diseases. They encourage the young 
to learn to swim, and supply an excellent form of exercise, 
promoting growth and development. When properly used 
their effects are both tonic and stimulating. 

What is sewer gas? How does the inhalation of sewer 
gas in large quantities affect the system? 

Sewer gas is a mixture of a number of gases among which 
we find carbonic acid gas, light carburetted hydrogen, nitro- 
gen, hydrogen sulphid, ammonium sulphid, with fetid or- 
ganic matter, the volatile and semi-volatile results of animal 
and vegetable decompositions. 

Sewer gas gaining entrance to house or room may exert a 
depressing influence upon the occupants, and may occasion 
vomiting, purging, severe headache, prostration, and through 
its carriage of germs cause infectious diseases. Yet sewer 
gas per se is sometimes almost innocuous. A chronic form 
of poisoning from sewer gas gives rise to pallor, languor, fre- 
quent headaches, loss of appetite, diarrhoea, generally im- 
paired health and anemia, 

Is green wall paper objectionable, if so, why? 

Yes, because its color is often due to a compound of copper 
and arsenic, which after becoming damp dries, and is rubbed 
or blown from the walls, producing acute or more often, 
chronic forms of arsenical poisoning as well as mechanical 
irritation of fauces, conjunctiva, etc. 

Contrast the incubative stages of variola and measles. 

The incubative stage of variola is from six to seven days 
by inoculation, and from ten to fourteen days by infection. 
In measles it is from seven to ten days by inoculation and 
from seven to twenty-one days by infection. 



654 HYGIENE. 

What conditions and diseases in animals render their 
flesh unfit for food? 

" The flesh of all animals dead of internal diseases, or 
which have been killed while suffering from such diseases or 
animals killed by overdriving. The flesh of animals with 
contagious diseases that may be transmitted to man. The 
flesh of animals that have been poisoned. The flesh of ani- 
mals with severe infectious diseases, as pyaemia, etc. Flesh 
that contains parasites that may be transmitted to men. All 
putrid flesh." (Gerlach). 

Discuss detached wards versus many=storied buildings 
for a public hospital. 

Many wards in one building render the maintaining of dis- 
cipline and supervision easier. Quicker service, ease of com- 
munication, greater economy of administration are favored 
by many wards. Many-storied buildings prevent perfect 
isolation, and ventilation, render diminished supply of sun- 
light, lead to danger, as in removal, should fire occur ; so that 
the detached ward system seems preferable. 

Give a fair average death rate (a) in rural districts, (b) 
in towns of from 5,000 to 20,000, (c) in cities of over 
100,000 inhabitants. 

(a) 14, (b) 17, (c) 19 to 22 per thousand. 

Mention five preventable diseases. 

Tuberculosis, typhoid fever, cholera, yellow fever and 
malaria. 

Give the special hygiene of factories in which women 
and children are employed. 

Each child or woman should be allotted sufficient space to 
supply 3000 cubic feet of fresh air an hour by a not greater 
air movement than that which would change the air three 
times each hour. The temperature should be kept constant 
at about 65 degrees Fahr. Means should be employed to 
quickly remove dust or offensive and dangerous gases. Per- 



HYGIENE. 655 

sonal cleanliness should be facilitated by properly equipped 
wash rooms. The water closet fixtures should be ample and 
of proper construction. An infirmary should be provided 
for immediate treatment of injuries and suddenly occurring 
illnesses. 

In the selection of a site for a dwelling what is the best 
sanitary soil, sub=soil and topography? 

A light, dry soil as of gravel or sand that contains no ab- 
sorbed filth or sewage with a nearly constant level of ground 
water, avoiding clay or impermeable material both in the 
soil and in the sub-soil. The location should not be in low- 
lying districts, nor in localities which from the geological 
formation act as collectors of underground water. The 
house should not be placed on the top of an elevation where 
it would be exposed to strong winds. All other conditions 
being favorable, the house should be built on the side of a 
hill so that it receives a maximum supply of air and sun- 
light, and in cold climates preferably with a southern ex- 
posure. 

What is the bubonic plague? What steps can be taken 
to limit or extinguish such a scourge? 

It is an acute contagious and infectious disease favored by 
filthy surroundings and at times occurring epidemically. It 
is due to a specific micro-organism and is characterized among 
other symptoms by glandular swelling terminating in abscess. 
Prevention depends upon isolation of the sick, thorough dis- 
infection of the clothing, etc., and surroundings of the patient 
and the avoidance of overcrowding and filth, and the institu- 
tion of rigid quarantine to prevent its dissemination into a 
country. 

Name the principal adulterations of wine. 

Water, coloring agents (logwood, red beets, coal tar pro- 
ducts), flavoring agents (prunes, peaches, raisins, dates, dried 
apples), preservatives (salicylic acid, formaldehyde), glycer- 
ine, alum and decolorizing agents. 



656 HYGIENE. 

Give some of the requisites for the sanitary construc- 
tion of house foundations and cellars. 

To keep down the level of ground water subdrain if neces- 
sary to secure dryness. Coat the foundation inside and out 
with cement and provide a cement floor for the cellar. Admit 
plenty of air and sunlight into the cellar. 

What is your view concerning the propriety or neces= 
sity of inserting vaccine virus in multiple places? 

The duration of the protection from small-pox is said to 
be directly proportionate to the number and size of vaccine 
vesicles; so vaccinate in at least two different places and let 
the combined area of vesicle resultant measure over half 
an inch. 

Give the prophylaxis of the filth diseases. 

Sanitary inspection of all houses and buildings with im- 
mediate abatement of any nuisances. Thorough cleanliness 
applied to persons, habitations and the community, and to 
houses of public use. Examination of water and food sup- 
plies, with correction of all disease exciting causes. Sew- 
age and waste removal systems to be placed in perfect oper- 
ation. Isolation of patients sick with these diseases, and 
disinfection of rooms and property of such patients, and the 
establishment of house, municipal, state or national quar- 
antine. Prevent access of flies and other insects to food and 
drink. 

What is the physical training for a weak heart when 
no valvular lesions exist? 

Beginning with gentle calisthenics, exercise should be taken 
preferably in the open air and increased gradually. Such 
exercise to be supervised by a competent physician. Later on 
climbing exercises of a very gradual degree of difficulty may 
be taken. 

How many cubic feet of fresh air per hour are required 
by an adult? 

Three thousand cubic feet. 



HYGIENE. 657 

Describe the effects of a cereal diet. 

Many writers assert that as a rule such a diet produces a 
lessened muscular formation, with an increased fat produc- 
tion and that it also causes a deficient production of red 
blood corpuscles with an accompanying loss of oxidation and 
tissue removal; but it is probable that such a diet is com- 
patible with good health provided it contains enough proteids. 

What is the lowest temperature of steam heat at which 
pus cocci are destroyed? 

At 240 deg. Fahr. such organisms are killed in a few 
minutes, while at 212 deg. Fahr. it requires an exposure to 
steam of from thirty to forty minutes. 

What physical training would you recommend to a 
person with weak respiration? 

Calisthenic exercises without apparatus directed to in- 
creasing the extrinsic and intrinsic muscles of respiration, 
accompanied by deep and slow breathing. This should be 
followed by a course of light, well regulated gymnastic work, 
with dumb-bells, indian clubs and wands. After a proper 
interval of several months progressively difficult mountain 
climbing, then running exercises, and finally general appar- 
atus work in a good gymnasium under proper instruction. 

Name three tests for detecting impurities in water. 

Nessler's test for detecting and estimating ammonia. 
Nitrate of silver for detecting and estimating chlorides. 
Barium Nitrate for detecting and estimating sulphate. 

What is the best sanitary plan for the disposal of 
sewage? 

Collect the sewage in large tanks and to it add lime, alum 
or iron sulphate. Compress the solid materials after their 
subsidence or precipitation and cremate them. Allow the 
liquid sewage to flow upon specially prepared filter beds 
which are subdrained. and the water flowing from these sub- 
42 



658 HYGIENE. 

soil pipes may then pass into a stream without great danger 
of adding poisonous material or pathogenic bacteria. 

What is the temperature of tepid water, of hot water, 
of boiling water? 

Tepid water 75 to 85 degrees Fahr. 
Hot Water 100 to 110 degrees Fahr. 
Boiling Water 212 degrees Fahr. 

What diseases are propagated by drinking water? 
How can their spread be prevented? 

Infectious diseases, particularly cholera and typhoid fever ; 
diseases due to gastric and intestinal irritation, as forms of 
dyspepsia, diarrhoea, dysentery; diseases due to animal 
parasites ; diseases due to metallic poisons. 

Prohibit the use of water containing any dissolved metal. 
Distil the water, or boil it for at least one-half hour, thus 
purifying it. 

Describe in detail the sanitary precautions necessary 
in typhoid fever. 

Expose urine, stools, vomitus, and sputum, for three hours, 
to the action of a solution of chlorinated lime, of the strength 
of six ounces to a gallon of water, breaking up all solid 
masses. Place all towels, napkins and bed linen in a 5% 
solution of carbolic acid until convenient to boil the same 
for half an hour. Secure continuous ventilation of the sick 
room. Boil all water and milk before allowing its use by 
the patient or members of the household. Fumigate the room 
and contents after the patient leaves it. 

What hygienic precautions should be employed about 
diphtheria? 

Isolate the patient; refuse admission to the sick room of 
all whose presence is not necessary ; attendants should observe 
the greatest personal cleanliness; all secretions should be 
collected upon cloths and burned. All articles should be dis- 
infected before being removed from the sick room. Members 
of the household should be quarantined. 



HYGIENE. 659 

What principal hygienic direction should be given a 
patient suffering from tuberculosis? 

Always expectorate into or on such appliances as may with 
their contents be disinfected or burned. Avoid kissing. 

How can malarial districts be made healthy? 

Remove moisture from the locality by surface or sub-soil 
draining; by planting trees like the eucalyptus, which re- 
quire much water for their growth; by preventing the de- 
velopment of the mosquito larvae, through the action of 
petroleum on water surfaces. 

Differentiate between endemic and epidemic diseases. 

An endemic disease is one constantly present in a commun- 
ity. An epidemic disease is one which spreads rapidly, at- 
tacking many people at the same time. 

State the results to animal life of the combustion of 
fuel in a room without chimney connection or other 
ventilation. 

Carbon-monoxid poisoning , suffocation due to excessive 
quantity of carbon dioxide and diminished amount of oxygen ; 
a systemic poisoning due to breathing products which are the 
result of partial burning of excretions thrown off in ex- 
halations. 

What is the best method of disposing of the bodies of 
those who have died of yellow fever? 

Cremate such bodies. 

Through what media is the typhoid poison usually com= 
municated? 

Drinking water. Also by flies and other insects contamin- 
ating food. 

What is meant by natural and acquired immunity from 
disease? Give an example of each. 

By natural immunity we mean "that inherited trait from 
immune ancestors which enables an organism to resist the 



660 HYGIENE. 

attacks of bacteria and their toxic secretions." Thus, as a 
rule, the negro race do not contract yellow fever. By ac- 
quired immunity we understand that through a previous 
attack of an infectious disease, or by inoculation with 
an attenuated virus of that disease, the blood of the 
person undergoes such changes as to present a non- fertile soil 
to the organism to whose presence the' disease is due. Ex- 
ample, vaccination in preventing small-pox. 

What are the principal measures which you would 
employ for the prevention of the spread of infectious 
diseases? 

Isolate the patient and attendants; disinfect all substances 
removed from patient's room before their removal; establish 
the purity of water and food supplies ; disinfect the room and 
contents after patient's removal, and observe a precautionary 
quarantine. 

How would you prepare an artificial food for a new= 
born infant? 

Render cow's milk as alkaline as human milk. Dilute with 
water to reduce the quantity of casein to what it would be 
in maternal milk. Fat and sugar are increased by the addi- 
tion of cream and sugar of milk. To one pint of sterilized 
water 17% drachms of pure commercial sugar of milk are 
added and dissolved. This sugar water must be kept in a 
cool place and not be allowed to sour. When feeding time 
arrives two tablespoonfuls of cream, one of milk, two of lime 
water, and three of the milk sugar water are mixed, and as 
soon as this mixture has been warmed to proper tempera- 
ture it may be poured into the bottle and the food is ready 
for use. (Fisher.) 

What are the properties of oleomargarin compared 
with butter made in the usual way? 

Butter fat contains nearly 8% of the volatile fat; specific 
gravity never below 909.8; insoluble fatty acids form about 
Yo of the weight of butter fat; melting point of fat is 



HYGIENE. 661 

between 86° and 94° F. ; readily and completely soluble in 
ether. 

Oleomargarin fat contains about y 2 % of the volatile fats; 
specific gravity never above 904.5 ; insoluble fatty acids form 
about 95% of the total weight; melting point rarely above 
52° F. ; less soluble in ether and leaves a residue. 






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